Which of the following treatment is appropriate when there is a benzodiazepine overdose. Select all that apply.
A. Administration of syrup of ipecac.
B. Gastric lavage
C. Activated charcoal and a saline cathartic.
D. Hemodialysis
E. Administration of Flumazenil.
Correct Answers: B, C, and E
If ingestion is recent, decontamination of the GI system is indicated. Due to their many uses and addictive properties, benzodiazepines have been widely prescribed and abused since their development several decades ago. Today, there are over 50 different agents available on the worldwide market, and the high incidence of benzodiazepine overdose mirrors their widespread use and availability.
Option A: The administration of syrup of ipecac is contraindicated because of aspiration risks related to sedation. Ipecac syrup is not recommended for home use because of the fear of emesis after the onset of respiratory depression.
Option B: Gastric lavage is generally the best and most effective means of gastric decontamination. Initiate gastric lavage for clinically significant recent ingestions (ie, within 30 minutes). Ensure/monitor airway patency/protective reflexes during the above treatment.
Option C: Activated charcoal and a saline cathartic may be administered to remove any remaining drug. Single-dose activated charcoal is not routinely recommended, as the risks far outweigh the benefits. BZD is very rarely fatal in overdoses, and the altered mental status from BZD overdose greatly increases the risk of aspiration following oral charcoal dosing.
Option D: Hemodialysis is not useful in the treatment of benzodiazepine overdose. The mainstay treatment for acute benzodiazepine toxicity is supportive care, which may include endotracheal intubation to provide definitive airway management. Single-dose or multi-dose activated charcoal, hemodialysis, or whole bowel irrigation play no role in managing benzodiazepine toxicity.
Option E: Flumazenil can be used to acutely reverse the sedative effects of benzodiazepines, though this is normally done only in cases of extreme overdose or sedation. Flumazenil is a nonspecific competitive antagonist at the benzodiazepine receptor that can reverse benzodiazepine-induced sedation.
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