Key points in Critical Care Medicine

                       “Adapted from Oxford Textbook of Critical Care”

Management of Benzodiazepine Poisoning

• Benzodiazepines are the drugs most frequently involved in acute self-poisoning.
• Benzodiazepine overdose usually has a good prognosis. Most patients do well with careful observation and prevention of complications. Supportive care including oxygen, intubation, respiratory support, and fluid administration may be required in some cases.
• Care should be taken with elderly patients, or those with chronic obstructive pulmonary disease or liver disease. Fast- acting agents and ingestion of other central nervous system depressants, including alcohol, may present an additional risk.
• Early administration of activated charcoal in fully conscious patients who are able to protect their airway is only needed if there are co-ingestants.
• Flumazenil may help confirm the diagnosis, improve alertness, and prevent the need for respiratory support in some patients, especially after accidental poisoning in children. Contraindications include patients on long-term treatment and/or dependent on benzodiazepines, or those who have simultaneously ingested proconvulsant or prodysrhythmic substances, or at risk of increase intracranial pressure.