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Old 11-07-2012
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Drug Acute overdose of a benzodiazepine

A 35 yr old chronic alcoholic on long term diazepam therapy for anxiety disorder presents to the ER accompanied by his wife who states that she found him in an altered state of consciousness with an empty bottle of diazepam at his bedside. According to the "note" he took them more than 8 hours ago.
O/E decreased alertness with coarse nystagmus, ataxia, slurred speech, and postural unsteadiness.
What is the best next step in management?

A. Flumazenil
B. Activated Charcoal
C. Ipecac syrup
D. Gastric lavage
E. Supportive measures
F. Benzodiazepines levels
G. Whole bowel lavage
H. Dialysis
I. Pray
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Last edited by Novobiocin; 11-07-2012 at 05:34 PM.
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E. Supportive measures

it is extremely hard for Benzos to kill you because the toxic dose is over a thousand fold the therapeutic dose, besides if he trully took them 8 hours ago he would be dead by know which he isnt, jsut supportive measures with close attention to seizure and/or respiratory failure is all that is required, in case he develops seizures secondary to benzos withdrawal guess what.. we would give benzos to stop the seizure haha

Praying is also good tho
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Quote:
Originally Posted by XpaezX View Post
it is extremely hard for Benzos to kill you because the toxic dose is over a thousand fold the therapeutic dose, besides if he trully took them 8 hours ago he would be dead by know which he isnt, jsut supportive measures with close attention to seizure and/or respiratory failure is all that is required, in case he develops seizures secondary to benzos withdrawal guess what.. we would give benzos to stop the seizure haha

Praying is also good tho
What if he presented 2 hours after the ingestion?
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Originally Posted by Novobiocin View Post
What if he presented 2 hours after the ingestion?
I would still pick Observation; the thing is that one never knows if the patient is a chronic Benzo user or just his first dose.. If he had a full bottle of benzos then I would like to think he is a regular user... for the patient's sake, if one gives flumazenil to chronic users one can precipitate BDZ withdrawal which leads to status epilepticus.. so I rather just chill
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Originally Posted by XpaezX View Post
I would still pick Observation; the thing is that one never knows if the patient is a chronic Benzo user or just his first dose.. If he had a full bottle of benzos then I would like to think he is a regular user... for the patient's sake, if one gives flumazenil to chronic users one can precipitate BDZ withdrawal which leads to status epilepticus.. so I rather just chill
Single-dose activated charcoal is recommended for GI decontamination in patients with protected airway who present within 4 hours of ingestion.
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Originally Posted by Novobiocin View Post
Single-dose activated charcoal is recommended for GI decontamination in patients with protected airway who present within 4 hours of ingestion.

Haha nice one, but i didnt know the guy had a protected airway.. in the observation status one can protect the airway in case the dude starts to have a decrease respiratory rate...

And yes one must protect the airway because activated charcoal can cause emesis and in obtunded patients this could lead to aspiration

Nice question bro
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What if he presented less than 1 hour after ingestion and an empty bottle of TCA was also found ?
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What if he presented less than 1 hour after ingestion and an empty bottle of TCA was also found ?

OMG you twisted man!!!
IN that case I would give Sodium Bicarbonate to protect the heart, and depending on what I see I would act..

Maybe After protecting the airway I would also give activated charcoal?
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OMG you twisted man!!!
IN that case I would give Sodium Bicarbonate to protect the heart, and depending on what I see I would act..

Maybe After protecting the airway I would also give activated charcoal?
I am just covering all the angles so that they can't ask anything more on this topic.
Quote:
Gastric lavage is not recommended but may be considered if the presence of a lethal co-ingestant is suspected and the patient presents within 1 hour of ingestion.
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Originally Posted by Novobiocin View Post
I am just covering all the angles so that they can't ask anything more on this topic.

Hahaha nice! thats true.. gastric lavage is recommended if within the first 2 hours.. you are beating my ass and whipping the floor with it I LIKE IT!
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i got a small doubt............in TCA overdose, do we wait for the ECG confirmation of prolong QRS interval or pump sodium bicarbonate as soon as we hear TCA toxicity..??????
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i got a small doubt............in TCA overdose, do we wait for the ECG confirmation of prolong QRS interval or pump sodium bicarbonate as soon as we hear TCA toxicity..??????
You have to confirm it with the ECG (QRS of 100 milliseconds or greater) before giving sodium bicarbonate.
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What if there was no note?

and/or

no empty bottle?:sorry:
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Mm m i would give the cocktail for the coma patient; naloxone thiamine and after thiamine, dextrose
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