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
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
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 DifferentialsGuidelines
- Deprescribing benzodiazepine receptor agonists: evidence-based clinical practice guideline
- Self-harm in over 8s: short-term management and prevention of recurrence
More GuidelinesPatient leaflets
Anxiety
Depression in adults
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