First Things First (assess & Treat For The Following)
- Assess and treat the ABCs
- Primary manifestation of benzodiazepine intoxication/overdose is mental status depression; in severe cases, cardiorespiratory depression may also occur.
- Aggressive/expectant airway management for frank/anticipated inadequacy of protective airway reflexes
- Supine/Trendelenburg positioning and aggressive IV fluid therapy for hypotension
- GI decontamination
- Activated charcoal 1 g/kg PO or per NG tube is effective in most cases if administered early.
- Initiate gastric lavage for clinically significant recent ingestions (ie, within 30 minutes).
- Ensure/monitor airway patency/protective reflexes during the above treatments.
- Further therapy and immediate considerations
- Supportive care is the cornerstone of treatment.
- Evaluate for possible flumazenil administration, especially in life-threatening intoxications.
- Evaluate for other toxin/CNS depressant involvement and initiate appropriate diagnostic/treatment plans.
- Consider IV naloxone in setting of mixed overdose/intoxication (will not reverse benzodiazepine-induced cardiorespiratory depression).
- Evaluate for the specific benzodiazepine ingested/administered, in particular to determine its half-life. Shorter half-life benzodiazepines are associated with increased morbidity/mortality.
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