{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:40:03Z","timestamp":1756291203257,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,4,30]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>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\u2009mg 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\u2009mg of intravenous flumazenil. The blood for BZDs concentration showed alprazolam 268\u2009ng\/mL (20\u201340\u2009ng\/mL), lorazepam 861\u2009ng\/mL (20\u2013250\u2009ng\/mL) and their metabolites.<\/jats:p>","DOI":"10.1136\/bcr-2022-248796","type":"journal-article","created":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T12:56:39Z","timestamp":1653310599000},"page":"e248796","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Alprazolam and lorazepam overdose and the absence of brainstem reflexes"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8853-6568","authenticated-orcid":false,"given":"Suthimon","family":"Thumtecho","sequence":"first","affiliation":[{"name":"Division of Toxicology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sorawit","family":"Wainipitapong","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sedthapong","family":"Chunamchai","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suchai","family":"Suteparuk","sequence":"additional","affiliation":[{"name":"Division of Toxicology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,5,10]]},"reference":[{"key":"2025082702593346000_15.5.e248796.1","unstructured":"Curry SC , O\u2019Connor AD , Graeme KA . 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