Case history
Case history
A 24-year-old student is brought to the emergency department (ED) 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 12. She has a normal physical exam with no focal neurologic signs. Medical records show that the patient has a prescription for alprazolam for panic attacks. She denies coingestions other than alcohol, or other morbidity.
Other presentations
Patients with benzodiazepine (BZD) overdose may present to the ED in an obtunded state. There may be little or no history, and he or she may otherwise be known to be a healthy person. If brought in by a friend or relative, vague information may be gathered about the emotional state of the patient or the discovery of empty pill bottles. Medications with similar-sounding names to BZDs - 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.
Another presentation may result from administration of flunitrazepam, a potent BZD often surreptitiously given to victims for the purpose of robbery or rape. It is favored by perpetrators not only because it is a rapidly acting and powerful sedative, which can easily be disguised in a drink, but also because it is a powerful amnestic, making accusations and prosecution difficult. Flunitrazepam is prohibited in the US as a Schedule I Controlled Substance, but is widely marketed in some countries by Roche under the trade name Rohypnol. It is also a popular recreational drug, with street names such as Roofies, Roach, and Mexican Valium.[2] The patient may present to the ED indicating he or she was drugged, and had visited a bar alone the previous night. The patient may also note having no memory of the evening and may notice money stolen, or signs of physical or sexual attack.
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