Benzodiazepine toxicity - Revision history

Danbot: Add MedicationDose SMW entry for flumazenil; dose verified against toxicology references

2026-03-20T17:59:34Z

Add MedicationDose SMW entry for flumazenil; dose verified against toxicology references

← Revisión anterior		Revisión del 17:59 20 mar 2026
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	*Flumazenil-Induced Seizure		*Flumazenil-Induced Seizure
	**Treat with [[phenobarbital]] or [[propofol]]; benzodiazepines will not work		**Treat with [[phenobarbital]] or [[propofol]]; benzodiazepines will not work


			==Medication Dosing==
			*{{MedicationDose\|drug=Flumazenil\|dose=0.2 mg IV, repeat q1min\|route=IV\|context=Benzodiazepine antagonist (controversial)\|indication=Benzodiazepine toxicity\|population=Adult\|max_dose=3 mg\|notes=Contraindicated in chronic benzo use, TCA coingesion, seizure disorder}}

	==Disposition==		==Disposition==

Elcatracho: /* Background */

2021-01-28T05:55:11Z

Background

← Revisión anterior		Revisión del 05:55 28 ene 2021
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	*Isolated [[benzodiazepine]] overdose has low morbidity/mortality		*Isolated [[benzodiazepine]] overdose has low morbidity/mortality
	**Coingestion or parenteral administration accounts for vast majority of deaths		**Coingestion or parenteral administration accounts for vast majority of deaths
			**Respiratory depression rare with overdose of oral agents

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Flumazenil */

2017-03-12T05:11:39Z

Flumazenil

← Revisión anterior		Revisión del 05:11 12 mar 2017
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	===[[Flumazenil]]===		===[[Flumazenil]]===
	*Controversial		*Controversial
	**May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure		**May prevent need for [[mechanical ventilation]]; may precipitate benzo-withdrawal [[seizure]]
	*Indication:		*Indication:
	**Consider (though controversial) for coma reversal		**Consider (though controversial) for coma reversal
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	**0.2mg IV; may repeat q1min (max dose 3mg)		**0.2mg IV; may repeat q1min (max dose 3mg)
	*Flumazenil-Induced Seizure		*Flumazenil-Induced Seizure
	**Treat with phenobarbital or propofol; benzodiazepines will not work		**Treat with [[phenobarbital]] or [[propofol]]; benzodiazepines will not work

	==Disposition==		==Disposition==

Rossdonaldson1: /* See Also */

2017-03-12T04:53:10Z

Rossdonaldson1: /* Management */

2017-03-12T04:52:48Z

Management

← Revisión anterior		Revisión del 04:52 12 mar 2017
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	**[[Activated Charcoal]] x1		**[[Activated Charcoal]] x1
	*[[Mechanical ventilation]] if necessary		*[[Mechanical ventilation]] if necessary
	*[[Flumazenil]]
	**Controversial		===[[Flumazenil]]===
	***May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure		*Controversial
	**Indication:		**May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure
	***Consider (though controversial) for coma reversal		*Indication:
	**Contraindications:		**Consider (though controversial) for coma reversal
	***Suspected or known physical dependence on benzodiazepines		*Contraindications:
	***Suspected TCA overdose		**Suspected or known physical dependence on benzodiazepines
	***Co-ingestion of seizure-inducing agents		**Suspected TCA overdose
	***Known [[seizure]] disorder		**Co-ingestion of seizure-inducing agents
	***Suspected increased intracranial pressure		**Known [[seizure]] disorder
	**Dosing		**Suspected increased intracranial pressure
	***0.2mg IV; may repeat q1min (max dose 3mg)		*Dosing
	**Flumazenil-Induced Seizure		**0.2mg IV; may repeat q1min (max dose 3mg)
	***Treat with phenobarbital or propofol; benzodiazepines will not work		*Flumazenil-Induced Seizure
	*Withdrawal		**Treat with phenobarbital or propofol; benzodiazepines will not work
	**High risk - GABA activity withdrawn
	***CNS excitation:agitation, tremor, hallucinations, seizures
	***Autonomic Instability: tachycardia, hypertension, hyperthermia, diaphoresis

	==Disposition==		==Disposition==

Rossdonaldson1: /* Evaluation */

2017-03-12T04:51:50Z

Evaluation

← Revisión anterior		Revisión del 04:51 12 mar 2017
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	==Evaluation==		==Evaluation==
	*[[~~Utox~~]]		*[[Urine toxicology screen]]
			**Most [[benzodiazepine]] screens look for oxazepam, which is a metabolite of [[diazepam]] and [[chlordiazepoxide]]. Therefore, [[lorazepam]], [[alprazolam]], and [[clonazepam]] are commonly missed.
			**True positives: Oxazepam, [[temazepam]], [[diazepam]], [[alprazolam]], [[triazolam]]
			**False negatives: [[Lorazepam]], [[clonazepam]], [[midazolam]]

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2017-03-12T04:49:20Z

Evaluation

← Revisión anterior		Revisión del 04:49 12 mar 2017
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	==Evaluation==		==Evaluation==
			*[[Utox]]

	==Management==		==Management==

Rossdonaldson1 at 04:49, 12 March 2017

2017-03-12T04:49:02Z

← Revisión anterior		Revisión del 04:49 12 mar 2017
Línea 4:		Línea 4:

	==Clinical Features==		==Clinical Features==
	*Somnolence, slurred speech, ataxia (similar to ETOH intoxication)		*Somnolence, slurred speech, ataxia (similar to [[ETOH intoxication]])
	*Paradoxical reaction (more common in hyperactive children, psychiatric patients)		*Paradoxical reaction (more common in hyperactive children, psychiatric patients)
	*Hypotension		*[[Hypotension]]
	*Respiratory depression		*Respiratory depression

Línea 15:		Línea 15:

	==Management==		==Management==
	*GI decontamination		*[[GI decontamination]]
	**[[Activated Charcoal]] x1		**[[Activated Charcoal]] x1
	*Mechanical ventilation if necessary		*[[Mechanical ventilation]] if necessary
	*Flumazenil		*[[Flumazenil]]
	**Controversial		**Controversial
	***May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure		***May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure
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	==Disposition==		==Disposition==
	*Consider discharge after 6hr ~~obs~~		*Consider discharge after 6hr observation

	==See Also==		==See Also==

Rossdonaldson1 at 09:54, 11 March 2017

2017-03-11T09:54:08Z

← Revisión anterior		Revisión del 09:54 11 mar 2017
Línea 4:		Línea 4:

	==Clinical Features==		==Clinical Features==
	#Somnolence, slurred speech, ataxia (similar to ETOH intoxication)		*Somnolence, slurred speech, ataxia (similar to ETOH intoxication)
	#Paradoxical reaction (more common in hyperactive children, psychiatric patients)		*Paradoxical reaction (more common in hyperactive children, psychiatric patients)
	#Hypotension		*Hypotension
	#Respiratory depression		*Respiratory depression

	==Differential Diagnosis==		==Differential Diagnosis==
Línea 15:		Línea 15:

	==Management==		==Management==
	#GI decontamination		*GI decontamination
	##[[Activated Charcoal]] x1		**[[Activated Charcoal]] x1
	#Mechanical ventilation if necessary		*Mechanical ventilation if necessary
	#Flumazenil		*Flumazenil
	##Controversial		**Controversial
	~~###~~May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure		***May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure
	##Indication:		**Indication:
	~~###~~Consider (though controversial) for coma reversal		***Consider (though controversial) for coma reversal
	##Contraindications:		**Contraindications:
	~~###~~Suspected or known physical dependence on benzodiazepines		***Suspected or known physical dependence on benzodiazepines
	~~###~~Suspected TCA overdose		***Suspected TCA overdose
	~~###~~Co-ingestion of seizure-inducing agents		***Co-ingestion of seizure-inducing agents
	~~###~~Known [[seizure]] disorder		***Known [[seizure]] disorder
	~~###~~Suspected increased intracranial pressure		***Suspected increased intracranial pressure
	##Dosing		**Dosing
	~~###~~0.2mg IV; may repeat q1min (max dose 3mg)		***0.2mg IV; may repeat q1min (max dose 3mg)
	##Flumazenil-Induced Seizure		**Flumazenil-Induced Seizure
	~~###~~Treat with phenobarbital or propofol; benzodiazepines will not work		***Treat with phenobarbital or propofol; benzodiazepines will not work
	#Withdrawal		*Withdrawal
	##High risk - GABA activity withdrawn		**High risk - GABA activity withdrawn
	~~###~~CNS excitation:agitation, tremor, hallucinations, seizures		***CNS excitation:agitation, tremor, hallucinations, seizures
	~~###~~Autonomic Instability: tachycardia, hypertension, hyperthermia, diaphoresis		***Autonomic Instability: tachycardia, hypertension, hyperthermia, diaphoresis

	==Disposition==		==Disposition==

Rossdonaldson1: Text replacement - "benzos " to "benzodiazepines "

2016-07-31T10:21:06Z

Text replacement - "benzos " to "benzodiazepines "

← Revisión anterior		Revisión del 10:21 31 jul 2016
Línea 32:		Línea 32:
	###0.2mg IV; may repeat q1min (max dose 3mg)		###0.2mg IV; may repeat q1min (max dose 3mg)
	##Flumazenil-Induced Seizure		##Flumazenil-Induced Seizure
	###Treat with phenobarbital or propofol; ~~benzos~~ will not work		###Treat with phenobarbital or propofol; benzodiazepines will not work
	#Withdrawal		#Withdrawal
	##High risk - GABA activity withdrawn		##High risk - GABA activity withdrawn

← Revisión anterior		Revisión del 04:53 12 mar 2017
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	*[[Sedative/Hypnotic]]		*[[Sedative/Hypnotic]]
	*[[Benzodiazepines]]		*[[Benzodiazepines]]
			*[[Benzodiazepine withdrawal]]

	==References==		==References==