A 68-year old male was brought to our Emergency Room in coma, intubated and ventilated. The emergency doctor, who was on the ambulance, reported that the patient was found in his flat after the police pried up the door. empty packages. Due to the obscurity and genesis of the situation the emergency doctor decided for intubation and mechanical ventilation. No signs of intoxication were found, e.g. The patient registered for his funeral the night before on the answering machine of a local sepulchral company who informed the police. Initially found was a spontaneously breathing patient without any reaction to speech or pain.
Most clinical manifestations are somnolence, dizziness, amnesia, vomiting, ataxia and visual hallucinations with full recovery. We report a unique case of a man presenting in our Emergency Room with the highest recorded blood concentration (8.4 µg/ml) of Zolpidem and furthermore survived the overdose. Intoxications with Zolpidem, most in suicidal intent, are benign in the first place but can cause CNS and respiratory depression. Zolpidem is a benzodiazepine-receptor-1-agonist and serves as a short-acting hypnotic agent for the treatment of insomnia and anxiety. Signs and symptoms are dose-regulated and exacerbated by co-ingestion of other CNS or respiratory depressants.
Ulrich Demme Institute of Forensic Medicine, University of Jena.
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Most Mono- intoxications resulted in somnolence, dizziness, amnesia, vomiting, ataxia and visual hallucinations with full recovery ( 4, 5 ).
C Jung, R Gradinger, U Demme, J Rauchfuß, H Figulla. The Internet Journal of Toxicology. 2006 Volume 3 Number 2. Extreme Dose In Acute Zolpidem Intoxication. Original Article.
An excellent safety profile is shown for several years of clinical usage. It has been introduced as a short-acting hypnotic agent mainly for the treatment of insomnia. Therapeutically oral doses of 5 to 60 mg per day have been administered ( 1 ). It has high affinity to the omega-subtype of the benzodiazepine-receptor 1 and serves as an agonist. Zolpidem is an imidazopyridine derivate with strong sedative, myorelaxant and anticonvulsant properties.
Figulla Cardiology Department, Department of Internal Medicine I, University of Jena. Hans-R.
Jörg Rauchfuß Cardiology Department, Department of Internal Medicine I, University of Jena.
In the literature several intoxications with Zolpidem are described, mostly in suicidal intents. Signs and symptoms are dose -regulated and exacerbated by co-ingestion of other central or respiratory depressants. Primary effects of Zolpidem overdose involve CNS and respiratory depression. Many studies showed that oral benzodiazepine overdose rarely causes respiratory failure that requires mechanical ventilation ( 2 ). In all reported cases except in one the Zolpidem overdose included other medications that could explain the respiratory failure ( 3 ).
Extreme Dose In Acute Zolpidem Intoxication - Internet Scientific.
Blood glucose was 10.1mmol/l, creatinkinase 60.41 umol/l ( Author Information Christian Jung Cardiology Department, Department of Internal Medicine I, University of Jena. Due to the records of our hospital we got to know in the emergency department that the past medical history was significant for coronary artery disease, status post bypass-operation, arterial hypertension, diabetes mellitus type II and cerebral apoplexy. On presentation, blood pressure was hypertensive with 190/100 mmHg and pulse rate was 85/min. The physical examination was significant for a decreased level of conciousness with a Glasgow Coma score of 3.
Regarding cardiovascular complications hypotension was observed and in one case a 14-year-old female developed sinus tachycardia following the ingestion of 100 mg of Zolpidem ( 5, 6 ). We report a unique case of a man presenting in our Emergency Room with the highest recorded survived overdose and blood concentration of zolpidem.
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Robert Gradinger Cardiology Department, Department of Internal Medicine I, University of Jena.
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C Jung, R Gradinger, U Demme, J Rauchfuß, H Figulla.
Extreme dose in acute zolpidem intoxication