Last reviewed:October 2019
Last updated:August  2019

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
  • history of illicit drug or alcohol use
  • drug administration error
  • comorbidity
  • drug interaction
  • biogenetic susceptibility
  • history of benzodiazepine (BZD) use
  • history 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

Contributors

Paul M. Gahlinger

General Practitioner

Paradise Medical Group

Paradise

CA

Disclosures

PMG declares that he has no competing interests.

Peer reviewersVIEW 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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