II. Mechanism
III. Signs: Benzodiazepine Intoxication
- Classic presentation is Altered Level of Consciousness with normal Vital Signs
- Cardiopulmonary effects
- Respiratory Depression (esp. when combined with other substances, e.g. Alcohol)
- Hypotension
- Rarely lethal alone, but dangerous with Alcohol
- Neurologic effects
- Anterograde Amnesia
- Ataxia (esp. young children)
- Confusion
- Slurred Speech
- Miosis
- Spectrum of Decreased Level of Consciousness
- Drowsiness
- Lethargy
- Sedation
- Coma
IV. Differential Diagnosis
V. Management: Benzodiazepine Overdose
- See Unknown Ingestion
- Supportive care with airway management for CNS Depression
- Benzodiazepines Overdoses in isolation generally have good outcomes
-
Flumazenil (Romazicon)
- Read Flumazenil contraindications carefully
- Avoid in patients with chronic use (risks of severe withdrawal including Seizures)
- Most toxicology guidelines do not recommend Flumazenil in Overdose
- Potential harms appear to outweigh benefits in most cases
- Penningo (2016) Basic Clin Pharmacol Toxicol 118(1): 37-44 +PMID:26096314 [PubMed]
- May be indicated for acute Benzodiazepine Overdose (non-chronic use) with cardiopulmonary depression
- Young, healthy children with Accidental Ingestion and no significant prior use
VI. Management: Fake Xanax
- Fake Xanax contains Fentanyl and Etizolam (Benzodiazepine analog)
- Presents as opiod Overdose with sedation and respiratory depression (Rhabdomyolysis was also associated)
- Management
- Naloxone 0.4 mg
- Supportive care
- Consult poison control
- References
- Swadron and Nordt in Herbert (2017) EM:Rap 17(2):18
- ThePoisonReview.com
VII. References
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Related Studies
| Concepts | Injury or Poisoning (T037) |
| ICD9 | 969.4 |
| ICD10 | T42.4 , T42.4X1 |
| SnomedCT | 212662009, 81914009 |
| English | Benzodiazepines, Benzodiazepine poisoning, Benzodiazepine poisoning NOS, Poisoning by benzodiazepines, Pois-benzodiazepine tran, Poisoning by benzodiazepines NOS, Poisoning by benzodiazepine-based tranquilizers, Poisoning by benzodiazepine-based tranquillizers, Benzodiazepine poisoning NOS (disorder), Poisoning by benzodiazepine-based tranquilizer, Poisoning by benzodiazepine-based tranquilizer (disorder), Poisoning by benzodiazepine-based tranquilliser |
| German | Vergiftung: Benzodiazepine, Vergiftung durch Schlafmittel auf Benzodiazepinbasis |
| Korean | 벤조다이아제핀에 의한 중독 |
| Spanish | Intoxicación por tranquilizantes benzodiazepínicos, intoxicación por benzodiazepina, SAI, intoxicación por benzodiazepina, SAI (trastorno), intoxicación por tranquilizantes a base de benzodiazepinas (trastorno), intoxicación por tranquilizantes a base de benzodiazepinas |
| Portuguese | Intoxicação por tranquilizantes à base de benzodiazepinas |
| Italian | Avvelenamento da tranquillanti a base di benzodiazepina |
| French | Intoxication par tranquillisants à base de benzodiazépine |
| Dutch | vergiftiging door benzodiazepineachtige tranquilizers, Benzodiazepinen |
| Czech | Otrava benzodiazepinovými trankvilizéry |
| Japanese | ベンゾジアゼピン系トランキライザー中毒, ﾍﾞﾝｿﾞｼﾞｱｾﾞﾋﾟﾝｹｲﾄﾗﾝｷﾗｲｻﾞｰﾁｭｳﾄﾞｸ |
| Hungarian | Benzodiazepin-alapú trankvillánsok által okozott mérgezés |
Ontology: Benzodiazepine overdose (C0572933)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 296053004 |
| English | benzodiazepine overdose, benzodiazepines overdose, Benzodiazepine overdose, Benzodiazepine overdose (disorder) |
| Spanish | sobredosis de benzodiazepina (trastorno), sobredosis de benzodiazepina |
