Prolonged toxicity after a massive benzodiazepine overdose

Abstract

A 37-year-old man with longstanding bipolar disorder ingested flunitrazepam 60 mg, brotizolam 7. 5 mg, and etizolam 7 mg. He was immediately transferred to hospital. The patient arrived in the emergency department 60 min after ingestion of the drugs. Benzodiazepine is an antipsychotic, which is increasingly used in preference to older antipsychotic agents. Limited data are available concerning the toxic effects of benzodiazepine after deliberate overdose. A patient presented to our institution after massive benzodiazepine ingestion, and required prolonged ventilatory support because of the development of a coma and respiratory depression. Serum benzodiazepine concentrations were orders of magnitude higher than those associated with therapeutic doses, and remained elevated for several days after ingestion. The patient made a full recovery with only supportive care, despite having initial serum drug concentrations. Our findings indicate the potential for benzodiazepine ingestion to cause a coma, which may persist for several days after the overdose.