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Benzodiazepine overdose with dependence — SCE Acute Medicine MCQ

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HardToxicology and OverdoseBenzodiazepine overdose with dependenceSCE Acute Medicine

A 44-year-old man prescribed long-term diazepam is found somnolent after an intentional overdose. Respiratory rate is 12/min, oxygen saturation is 96% on air, airway reflexes are intact and ECG is normal. There is no evidence of opioid or tricyclic co-ingestion. What is the safest management?

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Correct answer: C — Observe with supportive airway and ventilation management

An isolated benzodiazepine overdose with a protected airway is managed supportively. Chronic benzodiazepine exposure makes flumazenil hazardous because abrupt receptor antagonism can precipitate withdrawal and seizures. Flumazenil is reserved for carefully selected, non-dependent patients after toxicology assessment, not used routinely.

Reference: https://bnf.nice.org.uk/drugs/flumazenil/