Sleeping pill poisoning

Sleeping pills, sedatives and tranquilizers (anxiolytics) are psychoactive medications and cause central nervous system depression, which is necessary for therapeutic purposes in certain conditions. However, it should be borne in mind that these drugs are characterized by a high degree of potential toxicity, and poisoning with sleeping pills is a real danger to life.

Epidemiology

According to national statistics, poisoning by sleeping pills accounts for about one fourth of all cases of poisoning in the home.

Among U.S. Adults, the prevalence of intentional high-dose sedative and sleeping pill ingestion is estimated to be 0.16-1%, and among persons with mental health disorders it is estimated to be 6%.

According to the UK Office for National Statistics, the most common poisoning is due to overdoses of Diazepam, Temazepam and Zolpidem taken with or without alcohol.

According to a study conducted in Sweden, almost 40% of suicides among the elderly due to drug poisoning are benzodiazepine poisonings.

Sleeping pills of this pharmacological group are associated with more than 30% of drug poisoning deaths in North America.

Causes of the sleeping pill poisoning

The main causes of poisoning by sleeping pills or pills for insomnia are violations of the rules of their use, first of all, taking in high doses - overdose.

There may be toxic effects of sleeping pills due to pharmacological (drug) interactions, when their effects are enhanced when certain drugs are taken at the same time, thereby causing combined drug intoxication.

For example, Phenobarbital, Nembutal, Barboval and other derivatives of diethylbarbituric acid increase CNS suppression when combined with alcohol and drugs containing ethyl alcohol (which slows the brain and depresses breathing), and when used concurrently with tranquilizers (anxiolytics): Monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs), which include antidepressants such as Amitriptyline, Valdoxan, Sertraline, Paroxetine, and others.

In addition, it is not uncommon to use sleeping pills in the presence of contraindications to their use, in particular, severe liver and/or kidney failure, cardiac diseases (especially problems with atrial-ventricular conduction), certain pathologies of metabolic nature, etc.

Benzodiazepine anxiolytics: Diazepam, Clonazepam, Temazepam, Phenazepam, as well as sedatives of other pharmacological groups can lead to poisoning. For more information - Benzodiazepines: benzodiazepine abuse [1]

As clinical practice indicates, in most cases of extremely severe sleeping pill poisoning, the poisoning is intentional.

Risk factors

Prolonged depression (anxiety-depressive syndrome) and certain mental illnesses with an increased likelihood of suicide and suicide attempts; alcohol abuse or drug addiction; presence of cerebral and/or cerebrospinal lesions of a structural nature; hepato-nephrologic diseases with decreased function; low blood pressure and slow metabolism (more common in the elderly and in the presence of chronic diseases) are identified by experts as factors

Pathogenesis

In cases of poisoning by sleeping pills, the pathogenesis is usually due to the presence in the body (in the blood plasma) of the patient of an amount of the drug that significantly exceeds the recommended dosage.

In such a situation, the negative effect on the CNS of barbiturates and benzodiazepines is associated with increased activity of gamma-aminobutyric acid type A (GABA-A) receptors and, accordingly, inhibition of neurotransmission in neurons of subcortical structures of the brain (including vasomotor and respiratory centers), increased opening time of ion channels and slowed transmission of nerve impulses. Thus, it leads to suppression of most functions of the central nervous system with corresponding consequences.

Symptoms of the sleeping pill poisoning

In mild cases, poisoning with sleeping pills resembles ethanol poisoning, and its first signs are a feeling of weakness and pronounced drowsiness, impaired balance and gait, headache and slurred speech, decreased diuresis. Ethanolamine group sleeping pills (Doxylamine, Sonmil, Donormil, etc.) in overdose cause hyperthermia, reddening of the skin, muscle spasms and loss of consciousness.

In case of a minor overdose, poisoning with the sleeping pill Zolpidem (other trade names are Zopiclone, Imovan, Somnol, Adorma), which belongs to the group of cyclopyrolones and is much more toxic than Diazepam, can cause lethargy and confusion. Taking this sleeping pill in larger amounts leads to decreased muscle tone and blood pressure, heart rhythm disturbances, respiratory depression and toxic coma. [2]

And especially dangerous are combinations of high doses of barbiturates and benzodiazepines with alcohol, antidepressants or anxiolytics (tranquilizers).

Acute poisoning with sleeping pills and sedatives (which calm and relieve anxiety) cause headaches and dizziness, increased drowsiness and general weakness, nausea with bouts of vomiting, depression of psychomotor reactions.

Also read: Acute barbiturate poisoning: symptoms, treatment

Symptoms exhibited by poisoning from sleeping pills and tranquilizers may include: dilated pupils, arterial hypotension, cardiac arrhythmias, tachycardia/bradycardia, nausea and vomiting, tremors and seizures, suppression of respiratory function and impaired consciousness in the form of sopor and coma.

Complications and consequences

If treated early, complications may be minor, but overdose of these drugs can also lead to long-term secondary complications, primarily cerebral and cardiac ischemia.

The consequence of a significant overdose is death by sleeping pill poisoning, which is caused by respiratory arrest due to pulmonary edema.

Diagnostics of the sleeping pill poisoning

Diagnosis is simplified if it is known exactly which sleeping pills caused the poisoning, but most patients are not able to help in collecting a reliable history: very often in sedative-pill poisoning, medical professionals have to examine comatose patients.

Blood and urine tests help to clarify the cause. At the same time, instrumental diagnostics consists of electrocardiography (ECG).

Differential diagnosis

Differential diagnosis should exclude hypoglycemic and myxedematous coma, as well as intoxication of the body with anticonvulsants (in particular, Carbamazepine), ethanol, methanol, ethylene glycol, opiates, carbon monoxide (carbon monoxide).

Treatment of the sleeping pill poisoning

Almost any poisoning refers to extreme conditions, so much depends on how timely and correctly the first aid for poisoning with sleeping pills is provided. What it includes, in addition to the use of activated charcoal - if the victim has not lost consciousness - and gastric lavage (the purpose of which is to stop or reduce the toxic effects of taken tablets or capsules), is detailed in the materials:

Methods of stimulating natural detoxification

Detoxification therapy

The general treatment of such poisoning is carried out in the intensive care unit, and its most important task is to ensure the stability of hemodynamics and respiratory function, for which, when the patient is unconscious, endotracheal intubation and subsequent artificial ventilation with constant monitoring of the heart.

Infusion solutions of glucose and sodium chloride are administered, intravenously - magnesium sulfate solution (in ventricular arrhythmia - sodium bicarbonate solution).

Detoxicant or antidote in poisoning with sleeping pills of benzodiazepine group (Diazepam, etc.) and cyclopyrolone group (Zolpidem, etc.) - Flumazenil, which is administered into a vein (every hour 0.3-0.6 mg).

In addition, drugs such as Aminostigmine or Galantamine, which belong to the group of cholinomimetic agents, can be used by injection. Used detoxification hemosorption - within 4-12 hours from the onset of symptoms of poisoning.

There is no antidote for barbiturates, but Etimizole or Bemegrid is administered intravenously to stimulate the CNS. Respiration and blood pressure are constantly maintained. Blood purification is also possible by hemodialysis.

Prevention

Regulating the prescription of psychoactive drugs and limiting their availability is important as prevention of such poisonings. In addition, signs of suicidal behavior should be identified in a timely manner and suicide attempts should be prevented.

Forecast

Ultimately, the prognosis of the outcome of sleeping pill poisoning will depend on the amount taken, the timeliness and adequacy of medical care and the severity of the patient's general condition. In cases of combined drug intoxication, the probability of lethal outcome is very high.