Benzodiazepines

Benzodiazepine overdose is common and typically only severe when complicated by:

• Co-ingestion of CNS depressant
• Pulmonary or cardiac disease
• Extremes of age

Epidemiology and Risk Factors

Pathophysiology

Aetiology

Clinical Manifestations

Typically:

• Drowsiness
• Dysarthria
• Ataxia
• Nystagmus

Occasionally:

• Paradoxical agitation
• Confusion

Diagnostic Approach and DDx

Investigations

Bedside:

Laboratory:

Imaging:

Other:

Management

Resuscitation:

Specific therapy:

• Pharmacological
  • Flumazenil
    • Not licensed for use in poisoning
    • Risk of VT, status epilepticus, or benzodiazepine withdrawal
    • Dosing:
      • 0.1mg per 1mg of midazolam
      • 0.2mg IV Q30s empirically
      • Up to 3-5mg as an initial dose, with repeated doses up to 3mg/hr
• Procedural
• Physical

Supportive care:

Disposition:

Preventative:

Marginal and Ineffective Therapies

Anaesthetic Considerations

Complications

Prognosis

Key Studies

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References

1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.