Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • impaired mental status
  • drowsiness, slurred speech, ataxia
  • coma
  • respiratory depression

Other diagnostic factors

  • decreased deep tendon reflexes
  • nystagmus
  • paradoxical stimulation

Risk factors

  • depression
  • hx of illicit drug or alcohol use
  • drug administration error
  • comorbidity
  • drug interaction
  • biogenetic susceptibility
  • hx of benzodiazepine (BZD) use
  • hx of polydrug or unknown substance ingestion
  • suicidal ideation or behaviour
  • older age

Diagnostic investigations

1st investigations to order

  • pulse oximetry
  • FBC
  • serum chemistry panel with blood glucose
  • serum ethanol
  • urine toxicology screen
  • ECG
  • flumazenil trial
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Paul M. Gahlinger

Adjunct Professor

Department of Family and Preventive Medicine

University of Utah Health Sciences Center

Salt Lake City

UT

Disclosures

PMG declares that he has no competing interests.

Peer reviewers VIEW ALL

Associate Professor Emergency Medicine and Medicine

Departments of Emergency Medicine and Medicine (Clinical Pharmacology)

NYU Medical Center

New York

NY

Disclosures

RSH declares that he has no competing interests.

Emeritus Professor of Clinical Pharmacology

University of Edinburgh and Western General Hospital

Edinburgh

UK

Disclosures

LP declares that he has no competing interests.

Consultant Physician/Honorary Senior Lecturer

Regional Drugs and Therapeutics Centre

Newcastle-upon-Tyne

UK

Disclosures

RT declares that he has no competing interests.

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