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.