Benzodiazepine overdose

Case history

A 24-year-old student is brought to the emergency department by her classmate, who is concerned that she may have ingested an excessive number of 'sleeping pills'. She has been distraught over a relationship and has admitted to taking an unknown number of pills an hour earlier. Before ingestion, she had drunk approximately 2 to 3 glasses of wine. On examination the patient has slurred speech and ataxia, but is oriented, with a Glasgow Coma Scale score of 14. She has a normal physical examination with no focal neurological signs. Medical records show that the patient has a prescription for alprazolam for panic attacks. She has no relevant past medical history and denies co-ingestions other than alcohol.

Other presentations

Patients with benzodiazepine overdose may present to the emergency department in an obtunded state. There may be little or no history, and they may otherwise be known to be a healthy person. If brought in by a friend or relative, collateral information may be gathered about the emotional state of the patient or the discovery of empty pill bottles. Medications with similar-sounding names to benzodiazepines - for example, clozapine (an atypical antipsychotic) and clonazepam - can be confused, with potential for severe overdose attributable to significant differences in the daily dose between the two drugs.

Benzodiazepines may also occasionally be used for the purpose of robbery or rape when they are surreptitiously given to victims without their knowledge. The patient may note having no memory of the event and may notice money stolen, or signs of physical or sexual abuse.