Division of Toxicology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
Department of Psychiatry and Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand.
BMJ Case Rep. 2022 May 10;15(5):e248796. doi: 10.1136/bcr-2022-248796.
Benzodiazepines (BZDs) rarely cause respiratory depression and death. On the other hand, high-dose BZDs may lead to profound sedation and diminished brainstem functions that mimic other structural brain lesions as described in our case: a 70-year-old unresponsive woman. She was hypothermic and had rapid shallow breathing. Her Glasgow Coma Scale score was E1V1M4, with pinpoint pupils and absent corneal, oculocephalic and oculovestibular reflexes. Other physical exams, laboratory testing and brain imaging were unremarkable. After two doses of 0.4 mg naloxone and intravenous thrombolytics were given, there were no significant responses, and the diagnosis remained a mystery. The cause of her unconsciousness was uncovered when her husband found empty bags of 80 tablets of alprazolam and lorazepam. Her consciousness and brainstem reflexes improved dramatically after 0.25 mg of intravenous flumazenil. The blood for BZDs concentration showed alprazolam 268 ng/mL (20-40 ng/mL), lorazepam 861 ng/mL (20-250 ng/mL) and their metabolites.
苯二氮䓬类药物（BZDs）很少引起呼吸抑制和死亡。另一方面，高剂量的 BZDs 可能导致深度镇静和脑干功能减弱，这类似于我们病例中描述的其他结构性脑损伤：一位 70 岁的无意识女性。她体温过低，呼吸急促且浅。格拉斯哥昏迷评分 E1V1M4，瞳孔针尖大小，角膜、眼头和眼前庭反射消失。其他体格检查、实验室检查和脑部影像学均无明显异常。给予两剂 0.4mg 纳洛酮和静脉溶栓治疗后，没有明显反应，诊断仍然是个谜。当她的丈夫发现 80 片阿普唑仑和劳拉西泮的空袋子时，她昏迷的原因才被揭开。静脉给予 0.25mg 氟马西尼后，她的意识和脑干反射显著改善。BZDs 浓度的血液检测显示阿普唑仑 268ng/mL（20-40ng/mL），劳拉西泮 861ng/mL（20-250ng/mL）及其代谢物。
