Case history
Case history
A 24-year-old student is brought to the emergency department (ED) by her classmate, who is concerned that she may have ingested an excessive number of "sleeping pills". She has been distraught over a relationship and has admitted to taking an unknown number of pills an hour earlier. Before ingestion, she had drunk approximately 2 to 3 glasses of wine. On examination the patient has slurred speech and ataxia, and has a Glasgow Coma Scale score of 12. She has a normal physical exam with no focal neurologic signs. Medical records show that the patient has a prescription for alprazolam for panic attacks. She denies coingestions other than alcohol, or other morbidity.
Other presentations
Patients with benzodiazepine (BZD) overdose may present to the ED in an obtunded state. There may be little or no history, and the patient may otherwise be known to be a healthy person. If brought in by a friend or relative, vague information may be gathered about the emotional state of the patient or the discovery of empty pill bottles. Drugs with similar-sounding names to BZDs - for example, clozapine (an atypical antipsychotic) and clonazepam - can be confused, with potential for severe overdose attributable to significant differences in the daily dose between the two drugs.
BZDs can also have been surreptitiously given to victims for the purpose of robbery or rape. Flunitrazepam is an example of a BZD used in this way; it is prohibited in the US as a Schedule I Controlled Substance, but is widely marketed in some countries by Roche under the trade name Rohypnol®. It is also a popular recreational drug, with street names such as Roofies, Roach, and Mexican Valium.[2] The patient may present suspecting they were drugged, having no memory of the event, and may notice money stolen or signs of physical or sexual attack.
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