What is Benzodiazepine Poisoning?
Benzodiazepine (BZD) is one of the hypnotics that can release anxiety, help one to sleep easily, relax the muscle, and treat epilepsy. Poisoning cases are mainly due to deliberate self-injury, and a few are due to abnormal metabolism of drugs. The mechanism of benzodiazepine is to decrease the activity of the neuron cell that can put people under sedation.
 
Symptom:
  1. Central nervous system (CNS): Sedation, drowsiness, fatigue, slurred speech, unstable gait and amnesia. Not causing actual damage to CNS.
  2. Cardiovascular system: Low blood pressure and heart rate, even cardiac arrest.
  3. Respiratory system: There is a greater chancevia venous injection in respiratory rate suppression or even respiratory arrest, especially for those with heart and lung disease. Aspiration pneumonia is poisoning by benzodiazepine’s main complications.
  4. Gastrointestinal system: Nausea and vomiting may happen in some cases.
  5. Hyponatremia, Rhabdomyolysis. If you have these symptoms above, it does not mean that you are experiencing benzodiazepine poisoning, but rather you still need to consult a doctor for diagnosis.
 
Treatment:
  1. Decreasing the re-absorption of drug: Emetic method is not suggested. In coma patients, we can do nasogastric lavage after keeping the airway patient, unless the patient has already been overdosed after two hours when arriving at ED. The better way is to only use bolus charcoal via a nasogastric tube every four to six hours and keep observation of the vital signs. Patients with mild symptoms of poisoning may not use gastric lavage and charcoal. The only thing we need to do is observe their breathing pattern. After 6 hours of observation, they can be discharged from hospital.
  2. Symptomatic treatment: Patients with hypotension or bradycardia can bolus a large amount of IV fluid and give vasopressors for correction, along with CNS and respiratory support (e.g., intubation).
  3. Antidote: Flumazenil (Anexate®) is the BZD antagonist that can inhibit GABA by competing neuron receptor with it. The effectiveness depends on the different type of BZD, the duration of patient’s intake, and the drug amount. However, giving it to an epilepsy patient with tricyclic antidepressants’ poisoning is forbidden.
 
Precaution:
  1. Aspiration pneumonia: Often occurs in unconscious elder people, and the best way is to help the patient sit up when eating or elevating the head of the bed.
  2. Pressure injury: Caused by lying for a long duration and the body is fixed. The position should be changed every two hours for prevention.
  3. Rhabdomyolysis: Same as above. One also needs to keep the body from being compressed for too long.
  4. Deep vein thrombosis: Associated with a patient lying or sitting for a long period, causing poor blood circulation and thrombus.
 
References
  1. Soyka, M., & München, B. (2019). Treatment of Benzodiazepine Dependence. Fortschritte Neurologie Psychiatrie Journal, 87(4), 259-270. doi: 10.1055/a-0836-7514 
  2. Singh, S., & Sarkar, S. (2016). Benzodiazepine abuse among the elderly. Geriatric Mental Health of Journal. 3(2), 123-130. doi:10.4103/2348-9995.195605
  3. Dear, J. W., & Bateman, D. N. (2016). Benzodiazepines. Medicine, 44(3), 145. doi: http://dx.doi.org/10.1016/j.mpmed.2015.12.025
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