Alzheimer’s Delirium and Dementia Q 41
Nurse Fred is assessing a client who has just been admitted to the ER department. Which signs would suggest an overdose of an antianxiety agent?
A. Suspiciousness, dilated pupils, and incomplete BP
B. Agitation, hyperactivity, and grandiose ideation
C. Combativeness, sweating, and confusion
D. Emotional lability, euphoria, and impaired memory
Correct Answer: D. Emotional lability, euphoria, and impaired memory
Signs of anxiety agent overdose include emotional lability, euphoria, and impaired memory. In long-term users who have developed dependence, cessation of BZDs can result in a withdrawal syndrome, with manifestations including anxiety, irritability, confusion, seizures, and sleep disorders. Alprazolam withdrawal syndrome may be especially severe, with associated delirium, psychosis, and hyperadrenergic states.
Option A: Benzodiazepines taken in toxic doses without other coingestants rarely cause a significant toxidrome. The classic presentation in patients with isolated benzodiazepine overdose will include central nervous system (CNS) depression with normal or near-normal vital signs. Many patients will still be arousable and even provide a reliable history.
Option B: Patients receiving prolonged parenteral administration of BZDs are at risk for propylene glycol poisoning (the diluent used in parenteral formulations of diazepam and lorazepam). Although rare, this may result in hypotension, cardiac dysrhythmias, lactic acidosis, seizures, or coma.
Option C: Classic symptoms include slurred speech, ataxia, and altered mental status. Respiratory compromise is uncommon in isolated benzodiazepine ingestions, but if taken with coingestants such as ethanol or other drugs/medications, respiratory depression can be noted. It is important to note that most intentional ingestions of benzodiazepines do involve coingestants, the most common being ethanol, leading to substantial respiratory depression and airway compromise.