Tuesday, 2 November 2021

Benzodiazepine Poisoning : Clinical Features and Management

 Benzodiazepine Poisoning

Benzodiazepines ( eg Diazepam ) rarely cause serious overdose when taken in high amounts.

But they can potentiate side effects of other medications such as barbiturates , tricyclic antidepressants alcohol etc.

Clinical Features of Benzodiazepine  overdose

Drowsiness

Dizziness

Ataxia

Dysarthria

Hypotension

Rarely : Coma and Respiratory depression

Fatal poisoning is rare but may occur from respiratory depression in the elderly patients and those with COPD.

Management:

Clear the Airway

Maintain ventilation

Monitor Respiratory rate and oxygen saturation , act to rectify these appropriately,

Provision of supportive care should be ensured.

Gastric lavage and activated charcoal are not indicated if a Benzidiazepine has been  taken in isolation.

Flumazenil is used as an antidote for Benzodiazepine poisoning.

It has a short duration of action ( less than one hour )

It reverses the effects of benzodiazepines within 1 minute.

Flumazenil should be used carefully as it can cause convulsions and cardiac arrhythmias and precipitate a withdrawal syndrome in patients who are dependent on  benzodiazepines.

Flumazenil should not be used in patients with combined benzodiazepines and tricyclic antidepressant poisoning in whom it can cause convulsions and cardiac arrest.

Flumazenil can be helpful in very severe BDZ poisoning but should be used on expert advise only.

As small dose as possible should be given ,First dose 0.2 mg / 2ml iv over 15 seconds.then 0.1 mg/ml  at 1 min intervals  if needed ( max dose 2 mg )

Careful observation is necessary.

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