Poisoning from - sedatives

Description

Overdose of benzodiazepines, Z-drugs, barbiturates, or GHB/GBL - see toxidromes-sedative-hypnotic for the clinical picture
This note focuses on overdose-specific management decisions rather than toxidrome recognition

Very common co-ingestant in deliberate self-poisoning
GHB overdose - narrow margin between recreational and lethal dose; common cause of sudden unexpected coma in young adults at parties/festivals

See toxidromes-sedative-hypnotic - GABA-A potentiation (benzodiazepines/Z-drugs, ceiling effect), direct channel opening (barbiturates, no ceiling), GABA-B/GHB receptor activity (GHB)

Clinical severity assessment (GCS, airway reflexes, resp rate) drives management more than a specific level
Exclude co-ingestants - the danger is almost always the combination, not the sedative alone (except barbiturates, GHB in large dose)
ECG, paracetamol level as routine in deliberate self-poisoning

Supportive care is the mainstay: airway positioning, oxygen, ventilation if needed, observation until conscious state normalises
Flumazenil not routinely recommended - risk of precipitating seizures in chronic benzodiazepine users, mixed overdose (esp. TCA/proconvulsant co-ingestion), or dependence -> reserve for carefully selected iatrogenic cases
GHB: no antidote - supportive care; even deep coma typically resolves within a few hours - avoid unnecessary intubation if airway can be protected/observed closely and recovery expected imminently
Barbiturates: supportive + consider multi-dose activated charcoal and urinary alkalinisation (phenobarbital only) to enhance elimination in severe cases

Aspiration pneumonitis from vomiting with a depressed airway reflex
Co-ingestion with opioids/alcohol -> synergistic, potentially fatal resp depression
Pressure injury/rhabdomyolysis from prolonged immobility if not turned/monitored

Full recovery is the norm with supportive care alone
Death, when it occurs, is almost always from unrecognised co-ingestion or unmonitored airway compromise rather than the sedative itself

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