What are the clinical manifestations of benzodiazepine poisoning?

Under normal circumstances, benzodiazepine poisoning primarily involves central nervous system (CNS) depression and presents with a wide range of clinical manifestations, mainly including CNS depression, respiratory depression, circulatory abnormalities, gastrointestinal symptoms, and psychiatric or behavioral disturbances. A detailed analysis is as follows:

1. Central nervous system depression: This is the most typical manifestation. Early signs include drowsiness, dizziness, fatigue, slurred speech, and slowed reaction time. As poisoning progresses, consciousness becomes increasingly impaired—progressing from drowsiness to stupor, and in severe cases, coma. Some patients may also experience ataxia, manifested as unsteady gait and clumsy movements.

2. Respiratory depression: In mild poisoning, breathing may be slightly slowed and shallow. Moderate to severe poisoning can suppress the respiratory center, leading to irregular breathing patterns, progressively shallower and slower breaths, and potentially respiratory arrest in severe cases. Elderly patients or those with pre-existing lung diseases are at higher risk for respiratory depression, which may easily lead to hypoxia.

3. Circulatory abnormalities: The circulatory system is usually stable in early stages, although some patients may develop bradycardia and mild hypotension. In severe poisoning, vasodilation and reduced myocardial contractility can result in significant hypotension, presenting as pallor, cold and clammy extremities, and weak pulse.

4. Gastrointestinal symptoms: These commonly occur early and include nausea, vomiting, abdominal pain, and bloating. Some patients may experience loss of appetite, and vomitus may have an unpleasant odor related to the ingested drug. These symptoms are associated with direct irritation of the gastrointestinal mucosa by the drug and CNS-mediated gastrointestinal dysfunction.

5. Psychiatric and behavioral abnormalities: A minority of patients may exhibit psychiatric symptoms during the initial phase of poisoning or during recovery, such as restlessness, agitation, hallucinations, and disorientation. Children and elderly patients are more prone to excitatory symptoms like agitation, likely due to uneven selective inhibition of the CNS by the drug.

Benzodiazepines must be used strictly according to medical instructions, avoiding overdose or concomitant use with alcohol or other sedatives. Medications should be stored safely in daily life to prevent accidental ingestion. Once suspected poisoning is identified, immediate removal from the exposure source, elimination of unabsorbed drugs, and initiation of emergency treatment are essential.