Benzodiazepine toxicity: Difference between revisions
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(Add MedicationDose SMW entry for flumazenil; dose verified against toxicology references) |
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*Flumazenil-Induced Seizure | *Flumazenil-Induced Seizure | ||
**Treat with [[phenobarbital]] or [[propofol]]; benzodiazepines will not work | **Treat with [[phenobarbital]] or [[propofol]]; benzodiazepines will not work | ||
==Medication Dosing== | |||
*{{MedicationDose|drug=Flumazenil|dose=0.2 mg IV, repeat q1min|route=IV|context=Benzodiazepine antagonist (controversial)|indication=Benzodiazepine toxicity|population=Adult|max_dose=3 mg|notes=Contraindicated in chronic benzo use, TCA coingesion, seizure disorder}} | |||
==Disposition== | ==Disposition== | ||
Latest revision as of 17:59, 20 March 2026
Background
- Isolated benzodiazepine overdose has low morbidity/mortality
- Coingestion or parenteral administration accounts for vast majority of deaths
- Respiratory depression rare with overdose of oral agents
Clinical Features
- Somnolence, slurred speech, ataxia (similar to ETOH intoxication)
- Paradoxical reaction (more common in hyperactive children, psychiatric patients)
- Hypotension
- Respiratory depression
Differential Diagnosis
Sedative/hypnotic toxicity
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
Evaluation
- Urine toxicology screen
- Most benzodiazepine screens look for oxazepam, which is a metabolite of diazepam and chlordiazepoxide. Therefore, lorazepam, alprazolam, and clonazepam are commonly missed.
- True positives: Oxazepam, temazepam, diazepam, alprazolam, triazolam
- False negatives: Lorazepam, clonazepam, midazolam
Management
- GI decontamination
- Mechanical ventilation if necessary
Flumazenil
- Controversial
- May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure
- Indication:
- Consider (though controversial) for coma reversal
- Contraindications:
- Suspected or known physical dependence on benzodiazepines
- Suspected TCA overdose
- Co-ingestion of seizure-inducing agents
- Known seizure disorder
- Suspected increased intracranial pressure
- Dosing
- 0.2mg IV; may repeat q1min (max dose 3mg)
- Flumazenil-Induced Seizure
- Treat with phenobarbital or propofol; benzodiazepines will not work
Medication Dosing
- Flumazenil 0.2 mg IV, repeat q1min IV (max 3 mg) — Contraindicated in chronic benzo use, TCA coingesion, seizure disorder
Disposition
- Consider discharge after 6hr observation