Protrahiert verlaufende Bromazepam-Intoxikation im höheren Lebensalter

Abstract

A 68-year-old woman was found unconscious and hardly breathing. Artificial ventilation was undertaken by an emergency physician who brought her to hospital. Physical examination provided no evidence of relevant organ abnormalities. Neurological examination of the comatose patient revealed absent brain-stem reflexes and spontaneous respiration. But no other focal neurological abnormalities were found. Routine laboratory tests, ECG, chest radiogram, Doppler sonography of arteries to the brain, lumbar cerebrospinal fluid and computed tomography of the skull were unremarkable. Toxicological tests discovered bromazepam intoxication (serum level 6 mg/l; maximal serum level after intake of 6 mg of the active constituent: 0.1 mg/dl). When bromazepam poisoning was demonstrated elimination of the drug was no longer feasible; the spontaneous course of the poisoning with slowly falling drug levels could thus be observed over 10 days. In parallel with the fall of bromazepam concentration in blood, restitution of breathing and of brain-stem reflexes was recorded until, 12 days after intake of the drug, normal functions had been restored. Central respiratory arrest occurred at a bromazepam serum level of 6 mg/l. Without intensive medical care the patient would not have survived.