Last reviewed: 6 Feb 2021
Last updated: 07 Aug 2019
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 investigations
1st investigations to order
- pulse oximetry
- CBC
- serum chemistry panel with blood glucose
- serum ethanol
- urine toxicology screen
- ECG
- flumazenil trial
Treatment algorithm
ACUTE
Contributors
Authors

General Practitioner
Paradise Medical Group
Paradise
CA
Disclosures
PMG declares that he has no competing interests.
Peer reviewers
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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