Benzo v. Alcohol OD

[tyrael]

To begin with, I'm not entirely sure if this below in ADD so apologies if not....

I'm having a little trouble with the diagnosis of benzodiazepine v. alcohol OD (obviously not with a real pt! lol). What I'd love would be a side-by-side comparison of the signs and symptoms of both benzodiazepine and alcohol OD.

Both being GABAergic one would assume they would produce quite similar effects during an overdose?

Other then the obvious (well the ones I can think of! ) of alcohol such as; vomiting, an obvious smell of alcohol, breathalyzer unit results (?? how common are these in ED? ) or blood work. Or possibly some effects due to the effects on NMDA, nAChRs, GPCRs.

Can you experience hypoglycaemia due to benzo OD? Just another idea since this is easy to test.

And of course for both; pt history, general doc/pt interaction, questions asked to the presenting pt or family/friends/people accompanying them.


Cheers!

 

[SNR]

Well benzodiazepines (for the most part) are fairly safe in an overdose. For example, taking 10 too many temazepam's than you should (don't ask!) will have you walking around like a zombie for a few days, along with amnesia, maybe some nausea and vomitting, and obviously doing things you shouldn't. However, as long as a truly insane amount of benzodiazepines aren't ingested and other drugs are not mixed with them, you don't have to worry all that much about short term organ damage or things like that.

Alcohol on the other hand is much much more dangerous in an overdose. You can get significant organ damage all over. Alcohol poisoning isn't anything to play around with. Entire nervous system depression (including autonomic nervous system function) is very dangerous. Vomitting will happen, and if the person is unconcious, well yeah. Choke.
Alcohol is a poison, and will kill a person much faster than benzodiazepines would.

~snr

 

[tyrael]

Thanks SNR! Yes, seperately I'm reasonably well knowledged in theses substances, separately. Plus the obvious resulting in the potentiating effects due to poly drug use. We all know the therapeutic range of (the common. - diaze, tempaz, onaze, etc) benzos are (generally. Not talking about the more rear or less utilized ones) quite safe!!! Hence superseding alternatives such as Barbs!

Actually, I had calculated at some point, that based on a 5mg diazepam tablet, to reach (which obviously may not neccessaily mean actual death) the LD50 of diazepam, roughly 300 tablets would need to be consumed. I know I'd find dropping that many myself.

 

[23536]

Part of ethanol OD has to do with an immune response:

http://www.sciencedaily.com/releases/2011/09/110929103059.htm

I don't think benzodiazepines activate the same mechanism to such an extent, if at all. Plus, ethanol is metabolized into acetaldehyde, which is itself a toxin.

 

[tyrael]

http://www.sciencedaily.com/releases/2011/09/110929103059.htm

Cheers mate for the link. I check it out once I'm on one of my boxes.....and probably add it to the 30 or so papers I waiting to read. >_< lol.

Thanks heaps for the replies guys however, like I said, I've got a reasonably good grasp on the -kinetic/-dynamics, enzymines and metabolizes involved, (shortterm and longterm) toxicity, blah blah.

Specifically I'm after diagnostic aids suchs as tools, memes, mnemonics, etc or better yet, obvious symptotic difference exhibited between each OD.

Tbh I'm feeling this maybe one of those "on the job/experience" kinda things.

 

[23536]

non-response to flumazenil should be conclusive

Hum Exp Toxicol. 1991 Jul;10(4):235-9.

Efficacy of flumazenil in acute alcohol intoxication: double blind
placebo-controlled evaluation.

Lheureux P, Askenasi R.

Emergency Department (Clinical Toxicology) Erasme University Hospital, Brussels,
Belgium.

Flumazenil acts as an antidote for pharmacological and toxic effects due to
benzodiazepines. Several isolated observations and short uncontrolled series have
also suggested a possible effect against the impairment of consciousness induced
by pure alcohol intoxication. Patients admitted in the emergency department with
coma related to acute alcohol (ALC) or pure benzodiazepine (BZD) intoxication
were randomized and treated blindly with either placebo or 1 mg flumazenil. A
modified Glasgow score was used to observe the evolution of consciousness. In the
18 ALC patients, 1 mg flumazenil was not more effective than placebo, whereas it
appeared to be very active in the BZD group. However, an open administration of
higher doses of flumazenil (2-5 mg) in 11 ALC patients, whose condition had not
initially improved, was followed by clear improvement of consciousness in five of
them. Flumazenil, administered at a dose usually active against BZD sedation,
does not improve CNS depression induced by ALC intoxication. Higher doses could
be more effective in some patients, but it should also be verified in a
placebo-controlled trial.

PMID: 1679645 [PubMed - indexed for MEDLINE]

 

[tyrael]

Thanks! The above post did actually cross my mind however as far as I was aware Flumazenil should not be uses diagnostically!?!? What dangerous may occur if administered when it shouldn't?

 

[Roger&Me]

Both being GABAergic one would assume they would produce quite similar effects during an overdose?

They may both be "GABAergic", but ethanol does a lot of stuff that benzos don't. It not only acts as a GABA agonist, it also causes GABA release; additionally, it increases synaptic dopamine and serotonin, increases ACTH, activates mu-opioid receptors and releases beta endorphins, increases CB1 activity, and acts as an NMDA antagonist. Lots of stuff going on there.

 

[tyrael]

They may both be "GABAergic", but ethanol does a lot of stuff that benzos don't. It not only acts as a GABA agonist, it also causes GABA release; additionally, it increases synaptic dopamine and serotonin, increases ACTH, activates mu-opioid receptors and releases beta endorphins, increases CB1 activity, and acts as an NMDA antagonist. Lots of stuff going on there.

Thanks Roger&Me! I guess what I'm trying to refer to is more so these other (as describe ^^^) interactions, effects, signs and symptoms, etc caused by ethanol (and not benzos) which I'm after .... and hence I assume one can then infer that the presenting pt's condition is due to ethanol poisoning as a posed to benzo OD. (?? ).

I guess having a decent understanding of say, excessive; CB1 activity, NMDA antagonism, etc. would help differentiate the two?



Sorry, I'm not exactly being very eloquent in this thread hey.