The Poisoned Patient With Altered Consciousness

Abstract

Analysis favors empirical administration of hypertonic dextrose and thiamine hydrochloride to patients with altered consciousness. Although rapid reagent test strips can be used to guide this therapy, they are not infallible, and they fail to recognize clinical hypoglycemia that may occur without numerical hypoglycemia. Administration of naloxone hydrochloride should be reserved for patients with signs and symptoms of opioid intoxication. Flumazenil is best left for reversal of therapeutic conscious sedation and rare select cases of benzodiazepine overdose.

Assessment for Deaths in Out‐of‐hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport

“…Despite these reports, naloxone is a safe medication with which to treat opioid overdoses, with most reports of its adverse effects occurring early after the drug's administration. [5][6][7][8] Given its excellent safety profile, naloxone has been used extensively in the out-of-hospital, emergency department, and inpatient settings to reverse the effects of opioid intoxication.…”

Management of Opioid Analgesic Overdose

“…Although the classic toxidrome of apnea, stupor, and miosis suggests the diagnosis of opioid toxicity, all of these findings are not consistently present. 32 The sine qua non of opioid intoxication is respiratory depression. Administration of therapeutic doses of opioids in persons without tolerance to opioids causes a discernible decline in all phases of respiratory activity, with the extent of the decline dependent on the administered dose.…”

A Poison Center's Ten-year Experience with Flumazenil Administration to Acutely Poisoned Adults

“…Concern is rooted in the possibility that an unknown overdose patient may have ingested a pro-convulsant drug or may be a chronic benzodiazepine user; use of flumazenil in such patients may antagonize any anticonvulsant effects and result in seizures. Additionally, benzodiazepine overdoses have low mortality, and the potential risk of seizures may be of greater concern (13,15,20). Although our study reveals an overall low frequency of seizures, and no seizures among the unknown overdose subjects, our data support the avoidance of flumazenil use in adults who have been exposed to a pro-convulsant drug.…”