THE MEDICAL MANAGEMENT OF INTOXICATION

Mild to moderate toxicity presents in a similar way to intoxication with alcohol, with slurred speech, ataxia and incoordination. Delirium may supervene with relatively small doses in the elderly. With more severe intoxication stupor and coma develop. To this point the effects of intoxication are similar for all sedative drugs. Significant differences are present between sedative classes when very high doses are consumed.

BARBITURATES

Toxicity may progress to fatal respiratory arrest or cardiovascular collapse. An additional danger is presented by

the potential of some barbiturates to induce tolerance to their therapeutic effects but less so to their lethal effects. The maintenance dose may then approach the lethal dose, and only small increases above the individual's regular dose can lead to death.

BENZODIAZEPINES

Benzodiazepines virtually never lead to death when ingested by themselves. The several deaths that have occurred involved the newer, short-acting high potency benzodiazepines such as alprazolam and triazolam (Litovitz, 1987). However, benzodiazepines are often implicated in deaths associated with polydrug misuse, when used in combination with alcohol, opiates, major tranquillisers or sedative antidepressants due to their synergistic CNS-depressant action (see appendix 9, page 129 for illicit drug/drug interactions).

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The above information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.