Benzodiazepine poisoning can cause central nervous system depression and respiratory depression within 30 minutes, especially when combined with other CNS depressants. Diagnosis is made through urine toxicology screening and response to the antagonist flumazenil. Treatment involves activated charcoal to absorb the benzodiazepines and administration of flumazenil in small doses to reverse effects, though it carries risk of seizures if other drugs are involved.

1. BENZODIAZEPINE POISONING
 Clinical features
 Diagnosis
 Treatment

2. CLINICAL FEATURES
 CNS depressant effects begin within 30 min of acute overdose
 Coma and respiratory depression can occur with ultra short acting agents
and when benzodiazepines are combined with other CNS depressants.
 Paradoxical excitation may occur early in the course of poisoning.

3. DIAGNOSIS
 Urine toxicology screen for benzodiazepine metabolites.
 Since immunoassays do not detect all benzodiazepines, a negative result
does not exclude the diagnosis
 A response to flumazenil confirm diagnosis.

4. TREATMENT
 Activated charcoal-it adsorbs benzodiazepines
 Flumazenil ,a competitive benzodiazepine receptor antagonist can reverse
CNS and respiratory depression.
1. Flumazenil 0.1 mg IV should be given at 1 min intervals until the desired
effect is achieved or a cumulative dose of 3 mg has been given.
2. If relapse of symptoms occur, flumazenil can be repeated ( at intervals of
20 min with a maximum dose of 3 mg/h
3. Flumazenil can cause seizures in patients who have co ingested tricyclic
antidepressants or who are physically dependent on benzodiazepines as a
result of chronic use