Benzodiazepine Intoxication Research Articles

Differentiating loss of consciousness causes through artificial intelligence-enabled decoding of functional connectivity

Differential diagnosis of acute loss of consciousness (LOC) is crucial due to the need for different therapeutic strategies despite similar clinical presentations among etiologies such as nonconvulsive status epilepticus, metabolic encephalopathy, and benzodiazepine intoxication. While altered functional connectivity (FC) plays a pivotal role in the pathophysiology of LOC, there has been a lack of efforts to develop differential diagnosis artificial intelligence (AI) models that feature the distinctive FC change patterns specific to each LOC cause. Three approaches were applied for extracting features for the AI models: three-dimensional FC adjacency matrices, vectorized FC values, and graph theoretical measurements. Deep learning using convolutional neural networks (CNN) and various machine learning algorithms were implemented to compare classification accuracy using electroencephalography (EEG) data with different epoch sizes. The CNN model using FC adjacency matrices achieved the highest accuracy with an AUC of 0.905, with 20-s epoch data being optimal for classifying the different LOC causes. The high accuracy of the CNN model was maintained in a prospective cohort. Key distinguishing features among the LOC causes were found in the delta and theta brain wave bands. This research advances the understanding of LOC's underlying mechanisms and shows promise for enhancing diagnosis and treatment selection. Moreover, the AI models can provide accurate LOC differentiation with a relatively small amount of EEG data in 20-s epochs, which may be clinically useful.

Autonomy and Its Limits

Autonomy and Its Limits

From suicide to accident – Case report – The significance of the medico-legal autopsies

IntroductionSuicide is the intentional and voluntary act of destroying one's own life, while an accident is an unintended event that involuntarily causes injury to one's health or destruction of life. Case presentationWe report a case of a 54-year-old male who was found in a forest in late November, approximately 500 m away from his car. He was positioned bent over a trunk of a tree with his head beneath the rest of his body. His pants were down to his knees, and there were soiled blades of grass and leaves on his body. Investigation of the case circumstances revealed that he had attempted suicide by carbon monoxide poisoning, using a hose connected to the exhaust pipe and running it through the window into the cabin. Window on the driver’s side was broken with glass particles on the driver's seat. Wrappers from “Rivotril” tablets, a generic benzodiazepine, were also found in the car.Autopsy revealed the following: postmortem hypostasis was of a cherry red color and well pronounced on the upper part of the front of the body and face. Numerous bruises, contusions, and erosions were present all over the body. Frostbites were especially pronounced in the knees and elbows area. The synovial membranes were partially bloodstained and reddish in color. Opening the stomach revealed erosions of the gastric mucosa (Wischnewsky sign).Chemical toxicological analysis detected presence of benzodiazepines and carboxyhemoglobin (25%). ConclusionBased on the autopsy findings, chemical toxicological analyses, and investigation of the case circumstances, it has been concluded that the death occurred due to the combined effects of hypothermia, postural asphyxia and carboxyhemoglobin and benzodiazepine intoxication. The manner of death in this case is a combination of accidental and suicidal, as the victim attempted suicide but ultimately died due to exposure to low external temperature.

General hospital admissions in young and middle-aged people who use psychoactive substances: Impact of Covid-19 lockdowns.

The Covid-19 pandemic offered a unique opportunity to investigate trends in hospitalizations related to psychoactive substance intoxication, since the usual health burden of social use at parties and gatherings was likely to be decreased during lockdowns and curfew periods. Since young adults are the main users of psychoactive substances for experimental and recreational purposes, this study identified and compared hospitalization trends in young adults and adults over 30 years old. This national cohort study was conducted using the French hospital discharge database. An interrupted time-series analysis for the period between 2014 and 2020 was performed in two groups: young (age 18-29) and other adults (30+) to ascertain the trends in the monthly incidence of hospitalization related to psychoactive substance intoxication (opiates, cocaine, benzodiazepines, psychostimulants, alcohol and cannabis). Hospitalization characteristics during the first and second lockdown and the period between them were compared to the reference period (from 01/01/2014 to 29/02/2020). Among 1,358,007 stays associated with psychoactive substance intoxication, 215,430 concerned young adults. Compared with adults 30+, hospitalization trends in young adults showed a greater decrease in the number of stays during lockdown, with a maximum decrease of -39% during the first lockdown (1,566vs. 2,576; CI95%: 2,285-2,868) versus -20% (10,212vs. 12,894; CI95%: 12,001-13,787) in the second lockdown. Presentations for alcohol intoxication decreased throughout the pandemic, particularly during the second lockdown, while admissions for benzodiazepine intoxication increased during both lockdowns. Admissions for cannabis intoxication increased throughout the entire period. Lockdowns were associated with fewer hospitalizations related to psychoactive substance intoxication in both age groups, especially among young adults, which might reflect a decrease in social use. Recreational use might therefore be an important target for prevention and risk minimization.

Features of Benzodiazepine Poisoning in the Elderly and Senile Patients

AIM OF THE STUDY To study benzodiazepine poisoning in geriatric patients compared to patients of working age.MATERIAL AND METHODS We examined 82 patients with benzodiazepine poisoning, hospitalized in the Department of Acute Poisoning and Somatopsychiatric Disorders of the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2020–2021, which were divided into age categories: young (18–44 years old), middle (45–59 years old) and older (over 60 years old) age. The presence of benzodiazepines in urine was confirmed by immunochromatographic analysis and gas chromatography–mass spectrometry (GC-MS). The concentration of phenazepam in the blood and urine was determined in 45 patients by GC-MS. Statistical processing of the material was performed using the IBM program SPSS Statistics 27.0. The median (Me), 25th and 75th percentiles were determined. The comparison of quantitative data was performed using non-parametric criteria, the level of significance was taken as p<0.05.RESULTS It was found that acute phenazepam poisoning prevailed in all age groups (90% of patients). Among young and middle-aged patients, moderate and deep stunning (GCS score 12–14) prevailed, and in older people moderate and severe poisoning prevailed (GCS score 3–12), with no statistically significant differences in blood concentrations of phenazepam between the groups. In patients of the older age group with benzodiazepine poisoning, compared to people of working age, the development of respiratory failure was statistically significantly more frequent — 13.8-fold, pneumonia — 12.6-fold, vein thrombosis of the lower extremities — 7.8-fold, trophic skin changes — 29-fold. The duration of treatment in older patients with benzodiazepine poisoning was 3.5-fold higher than in young and middle-aged patients, mortality in the older age group was 41%.CONCLUSION The course of acute poisoning with benzodiazepines, including phenazepam, in the elderly and senile age differs in comparison with persons of working age with a high incidence of complications and adverse outcomes.

High-potency benzodiazepine misuse in opioid-dependent patients: use naloxone with care

The misuse of highly potent benzodiazepines is increasing in the UK, particularly among the opioid-using population in Scotland. Differentiating opioid from benzodiazepine toxicity is not always straightforward in patients with...

259 Outcomes and Resource Utilization of Patients Presenting to the Emergency Department With Opioid and Benzodiazepine Poisoning

Recent literature shows many overdose deaths are associated with co-use of opioids and other drugs, such as benzodiazepines. However, the literature is sparse surrounding the characteristics and associated factors of people with co-use. Additionally, there are limited data evaluating treatment, outcomes, costs, disposition, and resource utilization related to co-users compared to those who use opioids alone.

The Spectrum of Toxicological Analysis in a Tertiary Care Setting-Pakistan

Objective: To determine the frequency of opiate, cannabinoid, amphetamine, benzodiazepine, barbiturate, organophosphate, alcohol and related drugs of abuse poisonings in the tertiary care setting.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Toxicology & Therapeutic Drug Monitoring, Armed Forces Institute of Pathology, Rawalpindi, from Apr 2014 to Mar 2019.
 Methodology: Random sampling was done, and specimens of blood in an EDTA bottle, urine in a plain container and gastric lavage in a syringe were collected for drugs of abuse (Opiate, Cannabinoid, Amphetamine, Benzodiazepine, Barbiturate, Organophosphate) and alcohol. The screening was done on fluorescence immunoassay and Microarray Technology, while confirmation was done on Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS) for all drugs of abuse except alcohols and Gas Chromatography (GC-Head space) for alcohols.
 Results: 146,601 toxicological tests were divided into two categories according to request forms; clinical toxicological cases 92,333 (63 %) and forensic toxicology 54,268 (37%). The maximum no of cases were routine toxicological analysis of blood, urine, and gastric lavage, 89,169 (60.8%) tests, and emergency toxicology cases were only 1,708 (1.2%) tests in clinical toxicology. Forensic toxicology included a maximum of no cases of routine workplace testing (two drug panel testscannabinoid and opiate) 43,850 (29.9%), and post mortem toxicology cases were only 6912 (4.7%). The frequency of benzodiazepine poisoning was maximum 1390 (28.5%) than cannabinoid and opiate poisoning, i.e., 180 (3.7%) and 210 (4.3%) respectively, in clinical toxicology cases. The frequency of benzodiazepine poisoning was still maximum 501 (22.2%) than Cannabinoid, Amphetamine and opiate poisoning, which were....

Postmortem metabolic fingerprinting in death investigations

Explore the possibility of using postmortem metabolic fingerprinting for determine cause of death. We have previously demonstrated that the low-weight molecules present in a biological system after death has the potential to reflect the events leading up to death. That molecular overview (i.e. the postmortem metabolome) could potentially be used as a fingerprint useful in determining the cause of death. In Sweden, approximately five thousand forensic autopsies are carried out each year where approximately fifteen hundred cases have died either from drug intoxication ( n ≈800), strangulations by hanging ( n ≈500), pneumonia ( n ≈150) or acidosis ( n ≈50). The aim of this study was to investigate if our toxicological screening could be used to generate a postmortem metabolic fingerprint of autopsy cases that died either from drug intoxication, strangulation by hanging, pneumonia or acidosis. All autopsy cases handled at the Swedish National Board of Forensic Medicine between June 2017 and October 2020, in which the cause of death was opioid and benzodiazepine intoxications, hanging, pneumonia or acidosis, with a toxicological screening in femoral blood, with a BMI between 18,5–30 kg/m 2 , with an age between 30–65 years, were considered for this study. From each of the four causes of death, twenty-nine autopsy cases were randomly selected ( n = 116). The ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-QTOF) data were processed using XCMS (R) and evaluated with principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA). Three quarters of the samples ( n = 88) were used for model building while the remaining quarter ( n = 28) were used for external model validation. A simplified model was built with the most pronounced and significant chromatographic peaks. The chromatographic peaks were identified using the online databases METLIN and HMDB. For the training set, with 1355 chromatographic peaks as x-variables a full group separation was observed and with a 100% correct classification of intoxication, hanging, pneumonia and acidosis cases. The model had a R2 and Q2 value of 0.88 and 0.49 respectively, indicating that the model described the data well and that the model was reproducible. For the validation set, 82% of the samples were correctly classified. In a simplified model, only based on 20 chromatographic peaks (e.g. acylcarnitines, aminoacids, ketonbodies, polyethyleneglycols, steroid hormones), 72% of the cases in the validation set were correctly classified. This study demonstates that postmortem metabolic fingerprinting could potentially be used as a quick screening approach in search of plausible cause of death which could be a vital addition in death investigations. Further, several of the identified chromatographic peaks seemed to be biologically relevant. For example, increased levels of cortisone and decreased levels of LysoPC observed in the pneumonia cases could reflect the severity of illness and the prolonged agonal period expected in pneumonia cases in comparison to the other cases. Furthermore, decreased levels of acylcarnitines were observed in the intoxication cases which could reflect the respiratory function and the mitochondrial activity, being an indicator for respiratory depression. Postmortem metabolic fingerprints is a promising tool in death investigations, but more studies are needed to fully explore its potential.

Application of Machine Learning Techniques to Help in the Feature Selection Related to Hospital Readmissions of Suicidal Behavior

Suicide was the main source of death from external causes in Spain in 2020, with 3,941 cases. The importance of identifying those mental disorders that influenced hospital readmissions will allow us to manage the health care of suicidal behavior. The feature selection of each hospital in this region was carried out by applying Machine learning (ML) and traditional statistical methods. The results of the characteristics that best explain the readmissions of each hospital after assessment by the psychiatry specialist are presented. Adjustment disorder, alcohol abuse, depressive syndrome, personality disorder, and dysthymic disorder were selected for this region. The most influential methods or characteristics associated with suicide were benzodiazepine poisoning, suicidal ideation, medication poisoning, antipsychotic poisoning, and suicide and/or self-harm by jumping. Suicidal behavior is a concern in our society, so the results are relevant for hospital management and decision-making for its prevention.

Recognizing benzodiazepine poisonings and providing appropriate treatment

Viktorija Antonova-Šiaudvytė1 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania Abstract Benzodiazepines are psychotropic drugs whose indications for use include short-term anxiety or insomnia, withdrawal syndrome, etc. Benzodiazepines selectively act on the central nervous system by causing depression. Benzodiazepine intoxication is manifested by increased sedation, sluggishness, dysarthria, ataxia, diplopia, tachycardia, and at higher doses may cause coma, respiratory depression or death. Flumazenil is administered only in cases of accidental poisoning, otherwise life support is used. Gastric lavage should be performed no more than 1 hour after ingestion. Activated charcoal or haemodialysis shows no signifficant effect. Due to the frequent prescription of these drugs and the development of dependence, it is necessary to have a good knowledge of the clinical signs of poisoning caused by these drugs and to be able to administer treatment. Aim: review the mechanisms of action, signs of intoxication and treatment tactics as described in the scientific literature. Conclusions: Benzodiazepines have become one of the most commonly prescribed group of psychotropic drugs in recent years. Although the use of these drugs has significantly decreased in Lithuania, irrational prescribing and use of anxiolytics is still observed. The mechanism of action of benzodiazepines is CNS depression, and intoxication is manifested by increased sedation, sluggishness, dysarthria, ataxia, diplopia, tachycardia, and at higher doses can cause coma, respiratory depression or death. Flumazenil is administered only in cases of unintentional poisoning, otherwise life support is used. Gastric lavage is possible less than one hour after ingestion. Activated charcoal or haemodialysis is not significantly affected. Methods: the international databases Pubmed and UpToDate were used for literature search. The following keywords or a combination of keywords were used in the search: benzodiazepines, indications for benzodiazepines, pharmacology of benzodiazepines, toxicity of benzodiazepines, benzodiazepine poisoning and treatment. Although every effort was made to analyse publications from the last 5 years, the citation period was not restricted. The results of the analysis of 19 articles out of 274 selected are presented in this article. Keywords: benzodiazepines, poisoning, flumazenil.

The trend of top five types of poisonings in hospitalized patients based on ICD-10 in the northeast of Iran during 2012-2018: A cross-sectional study.

Background and AimsPoisoning remains a major health issue in developing countries with high morbidity and mortality rates; also it is one of the most common causes of admission to hospitals. This study aimed to investigate the trend of the top five types of poisonings in hospitalized patients according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD‐10) in Imam Reza hospital, Mashhad, Iran.MethodsThis was a cross‐sectional study performed from March 20, 2012, until September 22, 2018. We collected data from all patients hospitalized for poisoning admitted to the poisoning center at Imam Reza hospital in northeast Iran. ICD‐10 was adopted to categorize all types of poisonings (T36‐T65). The results obtained were analyzed by SPSS 16.ResultsThirty‐four thousand eight hundred and ten cases were included. The mean age of the patients was 29.64 ± 14.69 years, of them, 50.7% were males. Benzodiazepine poisoning (T42.4) has the highest frequency among other subcategories and it was more common among females (60.5%). Opium poisoning (T40.0) has the highest mortality rate (5.4%) among other subcategories that is more common in males (72.0%). The mortality associated with narcotics was the highest frequency (2.7%). Suicide (83.6%) was the most common cause of poisoning. Most poisonings occurred in summer (27.4%).ConclusionThese findings could help health care managers and policymakers develop prevention and educational programs to reduce these poisonings and limit people's easy access to drugs and substances.

Comparison of Clinical Manifestations of Patients Poisoned with Tricyclic Antidepressants Alone or with Benzodiazepine Intoxication According to the Dose of Benzodiazepines.

Tricyclic antidepressants poisoning (TCA) is associated with cardiovascular complications, electrocardiographic abnormalities, and central nervous system toxicity. This study aimed to compare the clinical manifestations of poisoned patients with tricyclic antidepressants alone or with benzodiazepine (BZD) intoxication according to the dose of BZDs. In this case-control study, 120 patients with TCA poisoning were divided into four groups: the first group of TCA poisoning alone, the second group of TCA and BZD poisoning of <7.75 mg, the third group of TCA and B poisoning of 7.75 to 80 mg, and the fourth group of more than 80 mg of TCA and BZD poisoning. Patients' demographic, clinical, and cardiac information was extracted from their records at admission and 6 h after admission. Cardiac complications 6 h after referral and total cardiac complications between TCA and TCA low-dose BZD groups were significantly reduced in the low-dose BZD poisoning group. Comparison of TCA and TCA groups with a moderate dose of BZD showed a significant reduction in time six and total cardiac complications. However, due to the significant difference in TCA values between the two groups, the results are not significant. Comparing the two groups of TCA and TCA with a high dose of BZD, both 6-hour cardiac complications and total cardiac complications in the high-dose BZD group, it was significantly reduced. However, the loss of consciousness was also considerably greater in the high-dose BZD group than in the TCA group. Concomitant BZDs with TCA can reduce cardiovascular complications from TCA poisoning. However, with high doses of BZDs, there is a greater loss of consciousness.

Association Between Receipt of Overlapping Opioid and Benzodiazepine Prescriptions From Multiple Prescribers and Overdose Risk

The receipt of overlapping opioid and benzodiazepine prescriptions is associated with increased overdose risk. It is unknown whether this increase in risk varies when overlapping prescriptions are written by multiple prescribers vs 1 prescriber. To evaluate the association between receipt of overlapping opioid and benzodiazepine prescriptions from multiple prescribers and overdose risk. This cohort study was conducted using 2017 to 2018 claims from the Optum deidentified Clinformatics Data Mart. Participants were patients with private insurance or Medicare Advantage aged 12 years or older with overlapping opioid and benzodiazepine prescriptions. Data were analyzed from March through November 2020. For each patient, person-days on which opioid and benzodiazepine prescriptions overlapped were identified. The exposure was whether these prescriptions were written by multiple prescribers vs 1 prescriber. The outcome was a treated overdose, defined as the occurrence of 1 or more claims containing a diagnosis code for opioid or benzodiazepine poisoning on a person-day of opioid-benzodiazepine overlap. The association between exposure and outcome at the person-day level was estimated using logistic regression, controlling for opioid and benzodiazepine prescribing patterns, demographics, and comorbidities. The average marginal effect (AME) of the exposure, defined as the absolute difference in the probability of a treated overdose if all person-days of overlap involved prescriptions from multiple prescribers vs 1 prescriber, was calculated. Among 529 053 patients, the mean (SD) age was 61.2 (15.6) years and 350 857 (66.3%) were female patients. Mean (SD) follow-up was 198.7 (249.8) days. During follow-up, overdose occurred on 1 or more person-days of opioid-benzodiazepine overlap for 2288 patients (0.4%, or 1 in 231 patients). There were 52 989 316 person-days of opioid-benzodiazepine overlap. Among 19 895 457 person-days (37.5%) involving prescriptions from multiple prescribers, there were 1390 overdoses (7.0 per 100 000 person-days), and among 33 093 859 person-days (62.5%) involving prescriptions from 1 prescriber, there were 1302 overdoses (3.9 per 100 000 person-days). Overdose risk was increased 1.8-fold (95% CI, 1.6-1.9) on person-days of overlap involving prescriptions from multiple prescribers vs 1 prescriber. The association between multiple prescribers and increased risk of overdose persisted in adjusted analyses (adjusted odds ratio, 1.20; 95% CI, 1.10-1.31; AME, 0.91 per 100 000 person-days of overlap; 95% CI, 0.46-1.37). This study found that among patients already at increased risk of overdose owing to concurrent treatment with opioids and benzodiazepines, overdose risk was increased further when multiple prescribers were responsible for this treatment regimen compared with 1 prescriber. This increased risk was not fully accounted for by differences in prescribing patterns, demographics, or comorbidities. This finding suggests that other factors, such as poor care coordination, may be associated with the increase in risk.

Hypoglycemia in Patients With Pure Benzodiazepine Poisoning

Background: Various studies investigated the effects of benzodiazepines on insulin and blood glucose levels and provided contradictory results. The present study aimed to evaluate the clinical effects of benzodiazepine poisoning on hypoglycemia. Methods: This retrospective cross-sectional study (from 22/June/2018 to 22/December/2018) was conducted on all medical records of adult patients with benzodiazepine poisoning who were referred to Ali-Asghar Hospital. The required data were collected using a data-gathering form and then analyzed. Results: In total, 61 patients were enrolled in this study. Furthermore, 19 (31.2%) patients developed hypoglycemia. Besides, 50 (82%) patients used benzodiazepine for a suicide attempt, i.e. higher in patients with hypoglycemia (P&lt;0.0001). Multivariate logistic regression test data indicated that benzodiazepine consumption for suicide attempt (OR=47.978, P=0.001, 95%CI, 5.313-433.277), and the respiratory rate at the time of suicide (OR=0.549, P=0.023, 95%CI, 0.328-0.920) were predictive factors for hypoglycemia in patients with benzodiazepine poisoning. Conclusion: Our study data suggested that 31% of patients who were poisoned with benzodiazepines developed hypoglycemia. The suicidal use of drugs and respiratory rates were predictive factors for hypoglycemia in these patients.

Benzodiazepine poisoning in Morocco: epidemiological study.

Objective: This study aims to describe the main epidemiological characteristics of benzodiazepine intoxication in Morocco.&#x0D; Methods: This is a retrospective study of cases of benzodiazepine poisoning reported at the Poison Control and Pharmacovigilance Center of Morocco between 2012 and 2016.&#x0D; Results: During the period 2012-2016, 1,544 cases of benzodiazepine poisoning were recorded in Morocco. The average age of the addicts is 21.68 ± 14.41 years. According to the data of the study, 70% are Female, with a sex ratio of 2.25.The suicidal act represents a significant percentage with 31.5% of cases. Almost all patients were orally intoxicated with 97.1%.The signs presented are various according to the quantity ingested and the time elapsed before the treatment in particular the psychiatric, neurological, digestive and cardiovascular disorders. Unfortunately, three cases died. The other cases survived with or without sequelae.&#x0D; Conclusion: benzodiazepines are drugs used in the treatment of several disorders such as anxiety, insomnia and psychomotor agitation. Unfortunately, many people do not know how to use this type of medicine.which exposes them to poisoning, for this reason it is necessary to carry out sensitization campaigns for the good use of benzodiazepines at the national level.&#x0D; Bangladesh Journal of Medical Science Vol.20(2) 2021 p.396-400

Protective effect of flumazenil infusion in severe acute benzodiazepine toxicity: a pilot randomized trial.

We aimed to investigate the efficacy of flumazenil infusion in the maintenance of arousal and prevention of development of complications in severe benzodiazepine poisoning. Sixty severely poisoned patients (intubated due to loss of consciousness) intoxicated by sole benzodiazepines referred to Loghman Hakim hospital between May 2018 and August 2019 were considered to be included in the current study. All were evaluated for possible contraindications of flumazenil administration. If there were no contraindications, we continued supportive care in one group and supportive care plus flumazenil infusion in the second group. Following response to the stat dose of flumazenil, complications, hospital stay, and outcome were compared between these two groups. A total of 60 benzodiazepine-poisoned patients aged between 16 and 84 years old (37 males and 23 females) were enrolled. There was no statistically significant difference between these two groups regarding the period of hospital stay. Need for intubation significantly decreased in the infusion group. None of the patients experienced seizure or dysrhythmia. One patient died in the control group which received only a stat dose of flumazenil. Administration of flumazenil is safe in benzodiazepine-poisoned patients with appropriate indications. Flumazenil infusion can significantly decrease the need for intubation and subsequent ICU admission. Even though flumazenil is an expensive antidote, its administration may decrease the need for ICU beds in the setting of acute poisoning.

The Effect of Methylphenidate on Reed Scaling in Benzodiazepine Poisoning: A Prospective Trial.

BackgroundBenzodiazepine is one of the most important causes of substance abuse and intoxication throughout the world and Iran.ObjectiveThe aim of our study is to determine the role of stimulants in reversing CNS level in acute Benzodiazepine poisoning patients who were hospitalized at referral poison center.MethodThis was a randomized double-blind placebo-controlled trial study on 32 cases with pure acute Benzodiazepine poisoning from March 2016 to February 2017. Diagnosis of pure acute poisoning was based on history, and laboratory confirmation. We gathered the demographics, clinical data, laboratory data, hospitalization and outcome. Participants were randomized into two groups: Methylphenidate Group (MPH) and Placebo Group (PBO).ResultsThe randomized sample consisted of 32 participants who were predominately female (83%). The majority of the PBO group and the MPH group reported improvement in their consciousness with a significant difference between the two groups (p = .005). Paired sample t-test analyses on Reed Scale data revealed an increase in the probability of improvement during the trial for the MPH group compared to the PBO group. Furthermore, the HCo3 (bicarbonate) level has a significant p-value with respect to age groups (p = .02). None of our cases required either the ICU facility or intubation.ConclusionOur study provided the MPH superiority over PBO in reversing CNS symptoms in loss of consciousness in acute BZD poisoned patients. Thus, this trial provides concrete evidence that improvement in consciousness levels (Reed Scale rated) among those patients receiving MPH was associated with a methylphenidate use.

Benzodiazepine Intoxication in a Neonate by Maternal Use in Pregnancy

The abuse of benzodiazepines by pregnant women can cause intoxication in the neonate. Benzodiazepines can diffuse readily across the placenta to the fetus because of their high lipid solubility. After the sixth month of pregnancy, the loss of the cytotrophoblasts from the placenta further facilitates the transport of benzodiazepines across the placenta. They may persist for at least a week in pharmacologically active concentrations after administration of high dosages to the mother. We report about a floppy, drowsy and pulmonary impaired newborn delivered in the 36th week of gestation. The mother was a regular user of clorazepate, a long-acting benzodiazepine during pregnancy.

Poisoning with Drugs of Abuse: Identification and Management.

ABSTRACTSubstances of abuse include alcohol, nicotine, cannabinoids, opioids, sedatives, volatile solvents, stimulants, and hallucinogens. With the increasing prevalence of drug abuse in India, intensivists are likely to encounter more cases of intentional and accidental poisoning due to drugs of abuse. We aim to sensitize the intensivists to challenges involved in diagnosing and treating poisoning with drugs of abuse. We also aim to provide a hands-on primer that can augment the usual protocols of “approach to life-threatening poisoning”. A toxidrome approach along with urine drug testing can help in speedily arriving at a diagnosis and instituting definitive treatment. In this article, we discuss spurious alcohol poisoning (methanol poisoning), benzodiazepine, opioid, and stimulant poisoning in detail and poisoning due to other substances including newer psychoactive substances is discussed briefly.How to cite this articleShukla L, Ghadigaonkar DS, Murthy P. Poisoning with Drugs of Abuse: Identification and Management. Indian J Crit Care Med 2019;23(Suppl 4):S296–S304.