J Korean Soc Emerg Med.  2014 Apr;25(2):199-201.

A Case of Pulmonary Thromboembolism Complicating Acute Overdose of Benzodiazepines

• Choi JY
• Jeong J

Abstract

Acute pulmonary thromboembolism (PTE) is a major medical problem in many hospitalized patients with medical and surgical conditions, and venous thromboembolism is responsible for up to 15% of all in-hospital deaths. However, PTE complicating acute intoxication has been reported only rarely, and prophylaxis for venous thromboembolism is not routinely incorporated into the management of acute poisoning in emergency departments or general wards. We describe here a case of pulmonary thromboembolism that developed within 48 h of acute benzodiazepine overdose. A 47-year-old female patient was brought to the emergency department by ambulance. She had been found unconscious, and empty packages of medications prescribed by her psychiatrist and an empty bottle of liquor were found. The estimated drugs and amounts were alprazolam 22.5 mg, diazepam 150 mg, flunitrazepam 7.5 mg, fluoxetine 150 mg, and propranolol 600 mg. Approximately 40 hours after initial presentation, she complained of dyspnea and pulse oxymetry indicated 84%. Her arterial pH was 7.41, pCO2 41.6 mmHg, pO2 46.8 mmHg, and oxyhemoglobin saturation was 83.4%. The serum D-dimer concentration was 2.78 mcg/dL, and computed tomography of the chest showed acute PTE in the right upper lobar and segmental pulmonary arteries and both lower segmental pulmonary arteries. When caring for patients with sedative drug overdose, a high level of suspicion of PTE is required, and appropriate diagnostic and therapeutic measures might be undertaken when PTE is suspected. In addition, appropriate prophylaxis for venous thrombosis should be considered.

Keyword

Poisoning; Benzodiazepines; Pulmonary embolism

MeSH Terms

Alprazolam
Ambulances
Benzodiazepines*
Diazepam
Drug Overdose
Dyspnea
Emergency Service, Hospital
Female
Flunitrazepam
Fluoxetine
Humans
Hydrogen-Ion Concentration
Middle Aged
Oxyhemoglobins
Patients' Rooms
Poisoning
Propranolol
Psychiatry
Pulmonary Artery
Pulmonary Embolism*
Thorax
Venous Thromboembolism
Venous Thrombosis
Alprazolam
Benzodiazepines
Diazepam
Flunitrazepam
Fluoxetine
Oxyhemoglobins
Propranolol