Summary
Definition
History and exam
Key diagnostic 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 behavior
- older age
Diagnostic tests
1st tests to order
- pulse oximetry
- CBC
- serum chemistry panel with blood glucose
- plasma acetaminophen concentration
- serum ethanol
- urine toxicology screen
- ECG
Treatment algorithm
all patients
Contributors
Authors
Paul M. Gahlinger, MD, PhD, MPH

General Practitioner
Paradise Medical Group
Paradise
CA
Disclosures
PMG declares that he has no competing interests.
Peer reviewers
Linda Peng, MD
Assistant Professor of Medicine
HMC Improving Addiction Care Team (IMPACT) Lead
Oregon Health & Science University
Portland
OR
Disclosures
LP declares that she has no competing interests.
Kenneth Katz, MD, FACMT, FAAEM, FACEP
Emergency Medicine Physician
Lehigh Valley Physician Group
Allentown
PA
Disclosures
KK declares that he has no competing interests.
Ruben Thanacoody, MD, FRCP (Edin)
Consultant Physician/Honorary Senior Lecturer
Regional Drugs and Therapeutics Centre
Newcastle-upon-Tyne
UK
Disclosures
RT declares that he has no competing interests.
References
Key articles
Klega AE, Keehbauch JT. Stimulant and designer drug use: primary care management. Am Fam Physician. 2018 Jul 15;98(2):85-92.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Alcohol or other sedative or hypnotic drug overdose
- Hypoglycemia
- Hyponatremia
More DifferentialsGuidelines
- Self-harm: assessment, management and preventing recurrence
- Deprescribing benzodiazepine receptor agonists: evidence-based clinical practice guideline
More GuidelinesPatient information
Anxiety
Benzodiazepine overdose
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