Overdose : מינון יתר

4.9    Overdose
In any evaluation of an intoxication, the presence of multiple intoxication by possible use of several medicinal products, for instance in suicidal intent, should be considered.

Intoxication symptoms are more severe under the influence of alcohol and/or other centrally acting medicinal products.
 a) Symptoms of overdose

The symptoms of slight overdose include, for instance, confusion, somnolence, ataxia, dysarthria, hypotonia and muscle weakness.

In case of severe intoxication, central depression of the cardiovascular and respiratory function (cyanosis, loss of consciousness and even respiratory arrest, cardiac arrest) can occur (intensive monitoring required!)

In the attenuation phase, severe states of agitation are possible.
 b) Therapeutic measures in case of overdose
Apart from monitoring respiration, pulse rate, blood pressure and body temperature, I.V. fluid replacement as well as supportive measures and provision of emergency measures for any possible airway obstruction are indicated in general (if necessary intensive monitoring). In case of hypotention,
sympathomimetics can be administered. In respiratory failure, which can also be caused by peripheral muscle relaxation, assisted ventilation is indicated.
Morphine antagonists are contraindicated.

Because of high plasmaprotein binding and the large distribution volume, forced diuresis or hemodialysis are probably of little use in pure diazepam intoxication.

N.B.:
Flumazenil is indicated for the removal of the central depressant effect of benzodiazepines. It is therefore used in the following indications:
 Termination of benzodiazepine-induced and maintained anaesthesia in inpatients
   Reversal of benzodiazepine induces sedation as part of therapeutic measures in inpatients