Poisoning with benzodiazepines

Description:

Benzodiazepines contact  GAMK receptors, but, unlike  barbiturates, raise not time of stay  of chloric channels abroach, and probability of their opening in response to action  of GAMK. There are  benzodiazepines of long action (chlordiazepoxide,  clonazepam,  to klorazepa,  diazepam,  flurazepam,  to prazepa and  kvazepa),  short action (to alprazola,  lorazepam and  oxazepam) and  supershort action (to estazola,  midazolam,  temazepam and  to triazoles). All of them are zhirorastvorima, are well soaked up in a GIT and for 85-99% contact proteins of plasma. Their volume of distribution fluctuates from 0,3 to 2 l/kg.
Benzodiazepines are acid connections (a rka from 1,3 to 6,2). The main way of elimination - hepatic metabolism; some benzodiazepines have active metabolites. Products of metabolism of benzodiazepines are removed preferential with urine. T1/2 fluctuates of 2 h (at benzodiazepines of short action) to 8 days (at benzodiazepines of long action).

Symptoms of poisoning with benzodiazepines:

Symptoms (weakness, drowsiness, ataxy) appear in 30 min. after reception. At early stages  perhaps paradoxical excitement.  The coma and  respiratory depression meet seldom, generally at poisoning with benzodiazepines of supershort action or at a concomitant use of other means, the oppressing  TsNS.

Sometimes in urine it is possible to reveal products of metabolism of benzodiazepines. At the same time many of these means are not found at a standard toxicological research and therefore the negative take of such research still does not speak about anything. More sensitive sign - reaction to introduction  of a flumazenil.

Treatment of poisoning with benzodiazepines:

First of all take measures for removal of toxic agent from a GIT (give  absorbent carbon, sometimes repeatedly). If necessary hold events for breath stabilization. The competitive blocker of benzodiazepine receptors  flumazenit eliminates oppression of TsNS and breath; its appointment allows to avoid a trachea intubation. Flumazenil enter in/in in the increasing doses (0,2,0,3 and 0,5 mg) bucketed in 1 min., the effect will not be reached yet or the general dose will not make 3-5 mg. Careful observation as action of a flumazenil quickly comes to an end is necessary and the recurrence is possible. If the symptomatology renews, introduction of a flumazenil according to the above described scheme is repeated bucketed 20 min. (but no more than 3 mg/h). On flumazenit lack of reaction calls into question the diagnosis of poisoning with benzodiazepines.

At the patients accepting  tricyclic antidepressants,  psychostimulants and also it is long accepting benzodiazepines in high doses (with development of physical dependence),  flumazenit can cause  epileptic seizures. If there is a risk of development of a benzodiazepine  abstinence syndrome, enter a trial dose of a flumazenil - 0,1 mg in / century.

Extracorporal methods of a detoxication are inefficient.