Sedative/hypnotic toxicity - Revision history

Danbot: Strip excess bold

2026-03-22T09:30:52Z

Strip excess bold

Danbot: Add MedicationDose entry for flumazenil

2026-03-20T21:12:58Z

Add MedicationDose entry for flumazenil

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 *Chloral hydrate: Avoid catecholamines (epinephrine) if dysrhythmias present — may worsen ventricular irritability; consider beta-blockers for ventricular dysrhythmias
 *Meprobamate: Monitor for prolonged toxicity from bezoar; may require whole bowel irrigation or endoscopic removal; hemodialysis effective for severe toxicity
 ==Disposition==

Danbot: Formatting: removed bold

2026-03-19T16:15:44Z

Formatting: removed bold

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Ostermayer: /* See Also */

2026-03-12T23:46:47Z

Ostermayer at 23:46, 12 March 2026

2026-03-12T23:46:24Z

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Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T22:22:27Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

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	{{Sedatve/hypnotic toxicity types}}		{{Sedatve/hypnotic toxicity types}}

	==~~Diagnosis~~==		==Evaluation==
	{{Toxic Alcohols Anion/Osmolar Gaps}}		{{Toxic Alcohols Anion/Osmolar Gaps}}

Rossdonaldson1 at 04:28, 12 July 2016

2016-07-12T04:28:32Z

← Revisión anterior		Revisión del 04:28 12 jul 2016
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	==~~Types~~==		==Background==

			==Clinical Features==

			==Differential Diagnosis==
	{{Sedatve/hypnotic toxicity types}}		{{Sedatve/hypnotic toxicity types}}

	==~~Differential~~ Diagnosis==		==Diagnosis==
			{{Toxic Alcohols Anion/Osmolar Gaps}}

	{{Toxidrome Chart}}		{{Toxidrome Chart}}

			==Management==

			==Disposition==

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

Rossdonaldson1 at 04:10, 12 July 2016

2016-07-12T04:10:16Z

← Revisión anterior		Revisión del 04:10 12 jul 2016
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{~~Template:~~Toxidrome Chart}}		{{Toxidrome Chart}}

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

Ostermayer: Text replacement - "Category:Tox" to "Category:Toxicology"

2016-03-22T16:23:30Z

Text replacement - "Category:Tox" to "Category:Toxicology"

← Revisión anterior		Revisión del 16:23 22 mar 2016
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	*[[Toxicology (Main)]]		*[[Toxicology (Main)]]

	[[Category:~~Tox~~]]		[[Category:Toxicology]]

Rossdonaldson1: Rossdonaldson1 moved page Sedative/Hypnotic to Sedative/hypnotic toxicity

2015-03-12T16:14:57Z

Rossdonaldson1 moved page Sedative/Hypnotic to Sedative/hypnotic toxicity

← Revisión anterior	Revisión del 16:14 12 mar 2015
(Sin diferencias)

← Revisión anterior		Revisión del 23:46 12 mar 2026
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	*[[Benzodiazepine Toxicity]]		*[[Benzodiazepine Toxicity]]
	*[[Barbiturate Toxicity]]		*[[Barbiturate Toxicity]]
	*[[GHB ~~Toxicity~~]]		*[[GHB toxicity]]
	*[[Opioid Toxicity]]		*[[Opioid Toxicity]]
	*[[Alcohol Intoxication]]		*[[Alcohol Intoxication]]

← Revisión anterior		Revisión del 09:30 22 mar 2026
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	==Background==		==Background==
	*Sedative-hypnotics are a broad class of CNS depressants that enhance GABAergic inhibition or otherwise suppress CNS activity<ref name="statpearls">Simone CG, Bobrin BD. Anxiolytics and Sedative-Hypnotics Toxicity. In: ''StatPearls''. Treasure Island (FL): StatPearls Publishing; 2023. PMID 32809628.</ref>		*Sedative-hypnotics are a broad class of CNS depressants that enhance GABAergic inhibition or otherwise suppress CNS activity<ref name="statpearls">Simone CG, Bobrin BD. Anxiolytics and Sedative-Hypnotics Toxicity. In: ''StatPearls''. Treasure Island (FL): StatPearls Publishing; 2023. PMID 32809628.</ref>
	*Includes: ~~'''~~benzodiazepines~~'''~~ (most common), ~~'''~~barbiturates~~'''~~, ~~'''~~non-benzodiazepine receptor agonists~~'''~~ ("Z-drugs": zolpidem, zaleplon, eszopiclone), ~~'''~~GHB/GBL~~'''~~, ~~'''~~chloral hydrate~~'''~~, ~~'''~~meprobamate~~'''~~, and ~~'''~~older agents~~'''~~ (ethchlorvynol, glutethimide, methaqualone)		*Includes: benzodiazepines (most common), barbiturates, non-benzodiazepine receptor agonists ("Z-drugs": zolpidem, zaleplon, eszopiclone), GHB/GBL, chloral hydrate, meprobamate, and older agents (ethchlorvynol, glutethimide, methaqualone)
	*Sedative-hypnotics are among the most frequently reported drug classes in overdose-related ED visits<ref name="gummin">Gummin DD, Mowry JB, Beuhler MC, et al. 2022 Annual Report of the National Poison Data System (NPDS) from America's Poison Centers: 40th Annual Report. ''Clin Toxicol (Phila)''. 2023;61(10):1-224. PMID 38084513.</ref>		*Sedative-hypnotics are among the most frequently reported drug classes in overdose-related ED visits<ref name="gummin">Gummin DD, Mowry JB, Beuhler MC, et al. 2022 Annual Report of the National Poison Data System (NPDS) from America's Poison Centers: 40th Annual Report. ''Clin Toxicol (Phila)''. 2023;61(10):1-224. PMID 38084513.</ref>
	*Oral benzodiazepine overdose alone rarely causes significant morbidity or mortality; serious toxicity almost always involves '''co-ingestion''' (opioids, alcohol, other sedatives)<ref name="medscape">Kang M, Galuska MA, Ghassemzadeh S. Benzodiazepine Toxicity. In: ''StatPearls''. Treasure Island (FL): StatPearls Publishing; 2023. PMID 29489152.</ref>		*Oral benzodiazepine overdose alone rarely causes significant morbidity or mortality; serious toxicity almost always involves '''co-ingestion''' (opioids, alcohol, other sedatives)<ref name="medscape">Kang M, Galuska MA, Ghassemzadeh S. Benzodiazepine Toxicity. In: ''StatPearls''. Treasure Island (FL): StatPearls Publishing; 2023. PMID 29489152.</ref>
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	*Multi-dose activated charcoal (MDAC): May be beneficial for phenobarbital overdose (enhances elimination via "GI dialysis")<ref name="chyka">Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: single-dose activated charcoal. ''Clin Toxicol (Phila)''. 2005;43(2):61-87. PMID 15822758.</ref>		*Multi-dose activated charcoal (MDAC): May be beneficial for phenobarbital overdose (enhances elimination via "GI dialysis")<ref name="chyka">Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: single-dose activated charcoal. ''Clin Toxicol (Phila)''. 2005;43(2):61-87. PMID 15822758.</ref>
	*Whole bowel irrigation: Consider for meprobamate (bezoar formation) or sustained-release formulations		*Whole bowel irrigation: Consider for meprobamate (bezoar formation) or sustained-release formulations
	*Orogastric lavage is ~~'''~~not routinely recommended~~'''~~		*Orogastric lavage is not routinely recommended

	===Flumazenil (Benzodiazepine Antagonist)===		===Flumazenil (Benzodiazepine Antagonist)===
	*Competitive antagonist at GABA-A benzodiazepine binding site		*Competitive antagonist at GABA-A benzodiazepine binding site
	*Dose: 0.2 mg IV over 30 sec → 0.3 mg → then 0.5 mg doses q1min to a maximum of 3–5 mg		*Dose: 0.2 mg IV over 30 sec → 0.3 mg → then 0.5 mg doses q1min to a maximum of 3–5 mg
	*Duration of action: 45–90 min (shorter than most benzodiazepines → risk of ~~'''~~resedation~~'''~~)		*Duration of action: 45–90 min (shorter than most benzodiazepines → risk of resedation)
	*USE WITH EXTREME CAUTION / generally AVOID in the ED for undifferentiated overdose<ref name="statpearls"/>		*USE WITH EXTREME CAUTION / generally AVOID in the ED for undifferentiated overdose<ref name="statpearls"/>
	*Contraindications / high-risk situations:		*Contraindications / high-risk situations:
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	**No evidence of co-ingestion		**No evidence of co-ingestion
	**Safe disposition plan; psychiatric clearance if intentional ingestion		**Safe disposition plan; psychiatric clearance if intentional ingestion
	**Poison control consultation recommended for all significant ingestions: ~~'''~~1-800-222-1222~~'''~~		**Poison control consultation recommended for all significant ingestions: 1-800-222-1222

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