Management of airway and breathing when resources are not available to safely intubate and ventilate the patient.Diagnostic tool to avoid further investigation.Flumazenil is a competitive benzodiazepine antagonist.Controversial – should be used with caution.Activated charcoal is not recommended due to early onset of sedation and good outcomes are ensured by good supportive care.Screening: 12 lead ECG, BSL, Paracetamol level.

Resolution of CNS depression occurs within 12 hours (unless elderly or co-morbidities), ataxia will persist for longer and your patient may be a falls risk.

Large ingestions can rarely cause hypothermia, bradycardia and hypotension.

Profound coma is rare except with alprazolam or in mixed ingestions.

Ataxia, lethargy, slurred speech and reduced GCS.

Clinical features: correlate poorly to benzodiazepine levels.

Children: Ingestion of 1 -2 tablets manifests as mild sedation and ataxia within 2 hours.

Patients with a cardiac or respiratory history are at risk of greater complications.

Zolpidem and zopiclone rarely cause severe CNS or respiratory depression.

Alprazolam causes greater CNS depression and is more likely to require intubation and ventilation.The addition of other agents or ethanol will change your risk assessment and increase length of stay and mortality. Usually isolated benzodiazepine overdose causes only mild sedation and can be managed with simple supportive care.If patient is not protecting their airway or has an aspiration risk intubation is recommended.Duration of effect depends on CNS tolerance and redistribution, rather than rate of elimination.

Hepatic metabolism to active metabolites.Varied Volume of distribution 0.4 – 4L/kg.Simple mechanism, they enhance the inhibitory neurotransmitter GABA by increasing the opening frequency of chlorine. With good supportive care prognosis is excellent. Benzodiazepines are a frequent presentation either as a single ingesting or in combination.

We discuss the management of benzodiazepine overdose including zopiclone and zolpidem as which carefully selected cases to use flumazenil.

Lorazepam overdose antidote