Classic Presentation: Young adult presents comatose and is intubated for airway protection and subsequently awakens while in the emergency department. When awake, typically can be safely discharged.
CNS depression; ataxia, nystagmus, somnolence, seizure, coma
EEG may show no epileptiform changes
Respiratory depression; may also alternate between periods of apnea and hyperventilation
Worse with other CNS depressants (alcohol, benzodiazepines, etc)
Bradycardia, hypotension; ECG changes are rare
Nausea and vomiting GI symptoms
Hypothermia
Often found to have co-intoxicants
Usually young white male from nightclub
CNS and respiratory depression can resolve abruptly within minutes
Patients may become aggressive upon waking
EEG may show no epileptiform changes
Worse with other CNS depressants (alcohol, benzodiazepines, etc)
Patients may become aggressive upon waking
Recover in 2-6 hours
May be extubated and sent home
If longer than 6 hours, look for other cause
Can have cross tolerance with other drugs-alcohol and others that effect liver p450 cytochrome oxidase system
Gamma hydroxybutyrate toxicity
Absinthe
Oxalic acid toxicity
Barbiturates
Ethylene glycol toxicity
Benzodiazepines
Methane toxicity
Flunitrazepam 