Benzodiazepine overdose

Last reviewed: 4 Jun 2022
Last updated: 07 Aug 2019

Summary

Definition

History and exam

Key diagnostic factors

  • impaired mental status
  • drowsiness, slurred speech, ataxia
  • coma
  • respiratory depression
More key diagnostic factors

Other diagnostic factors

  • decreased deep tendon reflexes
  • nystagmus
  • paradoxical stimulation
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • pulse oximetry
  • CBC
  • serum chemistry panel with blood glucose
  • serum ethanol
  • urine toxicology screen
  • ECG
  • flumazenil trial
More 1st investigations to order

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Paul M. Gahlinger, MD, PhD, MPH
Paul M. Gahlinger

General Practitioner

Paradise Medical Group

Paradise

CA

Disclosures

PMG declares that he has no competing interests.

Peer reviewers

Robert S. Hoffman, MD

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.

Laurie Prescott, MD, FRCP (Lond), FRCP (Edin), FFPM, FRSE

Emeritus Professor of Clinical Pharmacology

University of Edinburgh and Western General Hospital

Edinburgh

UK

Disclosures

LP 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.

  • Differentials

    • Alcohol or other sedative or hypnotic drug overdose
    • Hypoglycemia
    • Hyponatremia
    More Differentials
  • Guidelines

    • Deprescribing benzodiazepine receptor agonists: evidence-based clinical practice guideline
    • Self-harm in over 8s: short-term management and prevention of recurrence
    More Guidelines
  • Patient leaflets

    Anxiety

    Depression in adults

    More Patient leaflets
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