special subjects
Sedatives
Symptoms and Signs of Sedative Toxicity
The signs of sedative intoxication are depression of deep tendon reflexes, fine lateral-gaze nystagmus, slightly decreased alertness with coarse or rapid nystagmus, ataxia, slurred speech, and postural unsteadiness. Increasing toxicity can cause nystagmus on forward gaze, miosis, somnolence, marked ataxia with falling, confusion, stupor, respiratory depression, and, ultimately, death. Overdose of a benzodiazepine rarely causes hypotension, and these drugs do not cause arrhythmias. When intake of therapeutic doses of sedatives is stopped or reduced below a critical level, a self-limited mild withdrawal syndrome can ensue. After only a few weeks of use, attempts to stop using the drug can exacerbate insomnia and result in restlessness, disturbing dreams, frequent awakening, and feelings of tension in the early morning. ). The symptoms of benzodiazepine withdrawal may fluctuate, and the intensity of the symptoms may not decrease steadily. Many people who misuse benzodiazepines have been or are heavy users of alcohol, and a delayed benzodiazepine withdrawal syndrome may complicate Withdrawal . is also similar to alcohol withdrawal. In people who chronically take in large doses of barbiturates, as well as in those who stop or decrease the dosage abruptly, a potentially life-threatening withdrawal syndrome similar to Withdrawal may occur. Occasionally, even after properly managed withdrawal over 1 to 2 weeks, a seizure may occur. Without treatment, withdrawal of a short-acting barbiturate can cause the following: Within the first 12 to 20 hours: Increasing restlessness, tremulousness, and weakness By the 2nd day: More prominent tremulousness, sometimes increased deep tendon reflexes, and increased weakness During the 2nd and 3rd days: Seizures (in 75% of patients who were taking≥800 mg/day), sometimes progressing to status epilepticus and death From the 2nd to the 5th day: Delirium, insomnia, confusion, frightening visual and auditory hallucinations, and often hyperpyrexia and dehydration 