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Benzodiazepine overdose mixed ingestion — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseBenzodiazepine overdose mixed ingestionSCE Acute Medicine

A 28-year-old woman is assessed on the acute medical unit. She is drowsy after taking diazepam and an unknown antidepressant. Respiratory rate is 9/min and ECG shows QRS 120 ms. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: A — Support airway and ventilation without routine flumazenil

Support airway and ventilation without routine flumazenil is the best answer because supportive care is safest because flumazenil can precipitate seizures in mixed overdose or dependence. Give nebulised salbutamol driven by oxygen is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Flumazenil has a narrow role in selected iatrogenic benzodiazepine toxicity.

Reference: Toxbase; BNF