Benzodiazepines poisoning with

Placebo-controHed studies In a doubleblind, randomized, placebo-controlled study in 105 unconscious adults with suspected drug overdose, 73 of whom had taken benzodiazepines, flumazenil caused adverse effects in nine cases agitation (n = 3), a depressive mood (n = 3), nausea and vomiting (n = 1), shivering (n = 1), and one severe adverse reaction—a sudden fall in blood pressure in a 28-year-old woman in deep coma after combined poisoning with benzodiazepines and maprotiline [95 "]. 

The consequences of benzodiazepine use in the elderly may be severe. Benzodiazepines are common in drug poisoning suicides in the elderly (Carlsten et al. 2003). This is especially apparent for the hypnotics flunitrazepam and nitrazepam. Benzodiazepines are also associated with an increased risk of motor vehicle crashes in the elderly (Hebert et al. 2007). 

Common adverse psychologic consequences of hallucinogenic drugs include panic reactions ("bad trips") and acute psychotic reactions with PCP. Treatment includes benzodiazepines for sedation and constant monitoring by a nondrugged companion for several hours. Acidification of the urine (see Chapter 59 Management of the Poisoned Patient) may hasten PCP excretion. 

Diflunisal Overdose (15 g) of diflunisal leads to poisoning, which could be fatal.51 Treatment can be given by gastric lavage and supportive care. Interactions of diflunisal with indomethacin, paracetamol, antacids, benzodiazepines, and probenecid have been reported.5 Concomitant use with indomethacin should be avoided, as this could cause fatal GI complications. 

Flumazenil is used as a benzodiazepine antagonist in the treatment of poisoning or the reversal of benzodiazepine effects in anesthesia 1,2) or in neonates (3). Guidelines for its use have been summarized (4). The problems in its use are those of dose adjustment, the risks of panic anxiety, seizures, or other signs of excessively rapid benzodiazepine withdrawal, and pharmacokinetic problems due to the short half-life of flumazenil (about 1 hour) compared with the longer half-lives of most benzodiazepines (5). Its use is also commonly associated with vomiting and headache, and rarely with psychosis or sudden cardiac death (SEDA-17,... 

The initial clinical review should include a search for known consequences of poisoning, which include impaired consciousness with flacddity (benzodiazepines, alcohol, trichloroethanol) or with hypertonia (tricyclic antidepressants, antimuscaiinic agents), hypotension, shock, cardiac arrhythmia, evidence of convulsions, behavioural disturbances (psychotropic drugs), hypothermia, aspiration pneumonia and cutaneous blisters, burns in the mouth (corrosives). 

There is no antidote to hemlock poisoning. Death is generally due to paralysis of respiratory muscles. After assessment of airway, breathing, and circulation with necessary supportive care, decontamination of the gastrointestinal tract should be undertaken for substantial recent ingestions. Oxygen and benzodiazepines should be administered as needed for patients experiencing seizures. 

Treatment - inhaling of aerosol mixtures with sodium bicarbonate - 3% solution and Novphyllin - stomach washing and intestine cleaning - in peroral intake of the poison - 10% Calcium gluconicum amp. 10 ml venally 3-4 times daily - benzodiazepine preparations - Diazepam ampoule 10 mg muscularly for convulsion incidents - oxygentherapy, respiratory reanimation and antishock preparations - applied by the established methods. 

Benzodiazepines (most often diazepam, sometimes midazolam) may also be of benefit by reducing anxiety and restlessness, reducing muscle fasciculation, arresting seizures, and possibly reducing morbidity and mortality when used in conjunction with atropine and pralidoxime. The use of benzodiazepines in nerve agent poisoning has been reviewed recently (Marrs, 2004) and is discussed in detail in Chapter 16 (Marrs and Sellstrom). 

---