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Volume 7, Issue 23 (Winter 2014)
IJT 2014, 7(23): 952-955 |
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Kazemzadeh N, Mohammadi S, Emamhadi M, Amirfarhangi A, Sanaei-Zadeh H. Electrocardiographic Manifestations of Benzodiazepine Toxicity. IJT 2014; 7 (23) :952-955
URL: http://ijt.arakmu.ac.ir/article-1-268-en.html
URL: http://ijt.arakmu.ac.ir/article-1-268-en.html
Nahid Kazemzadeh1 
, Saeed Mohammadi * 2, Mohammadali Emamhadi3 , Abdollah Amirfarhangi4 , Hossein Sanaei-Zadeh5
, Saeed Mohammadi * 2, Mohammadali Emamhadi3 , Abdollah Amirfarhangi4 , Hossein Sanaei-Zadeh5
1- Department of Forensic Medicine and Toxicology, Iran University of Medical Sciences, Tehran, Iran.
2- Department of Forensic Medicine and Toxicology, Iran University of Medical Sciences, Tehran, Iran. , drsm1980@gmail.com
3- Department of Forensic Medicine and Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4- Department of Cardiology, Hazrat Rasoul Akram(p)Hospital, Iran University of Medical Sciences, Tehran, Iran.
5- Emergency Department /Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
2- Department of Forensic Medicine and Toxicology, Iran University of Medical Sciences, Tehran, Iran. , drsm1980@gmail.com
3- Department of Forensic Medicine and Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4- Department of Cardiology, Hazrat Rasoul Akram(p)Hospital, Iran University of Medical Sciences, Tehran, Iran.
5- Emergency Department /Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Abstract: (6632 Views)
Background: The aim of this study was to evaluate and compare the clinical and electrocardiographic (ECG) manifestations of benzodiazepines (BZs).
Methods: In this retrospective study, all BZ-poisoned patients hospitalized at Loghman Hakim Hospital between September 2010 and March 2011 were evaluated. Patients’ information including age, sex, time elapsed between the ingestion and presentation, and type of the BZ used were extracted from the patients' charts and recorded. ECGs on presentation to the emergency department (ED) were evaluated and parameters such as PR interval, QRS duration, corrected QT, amplitude of S wave in lead I, height of R wave and R/S ratio in the lead aVR were also measured and recorded.
Results: Oxazepam, chlordiazepoxide, lorazepam, alprazolam, diazepam, and clonazepam were ingested by 9 (3%), 13 (4.4%), 29 (9.9%), 105 (35.8%), 65 (22.2%), and 72 (24.6%) patients, respectively. Mean PR interval was reported to be 0.16 ± 0.03 sec and PR interval of greater than 200 msec was detected in 12 (4.5%) patients. Mean QRS duration was 0.07 ± 0.01sec and QRS≥120 msec was observed in 7 (2.6%) cases.
Conclusion: Diazepam is the only BZ that does not cause QRS widening and oxazepam is the only one not causing PR prolongation. It can be concluded that if a patient refers with a decreased level of consciousness and accompanying signs of BZ toxicity, QRS widening in ECG rules out diazepam, whereas PR prolongation rules out oxazepam toxicity.
Methods: In this retrospective study, all BZ-poisoned patients hospitalized at Loghman Hakim Hospital between September 2010 and March 2011 were evaluated. Patients’ information including age, sex, time elapsed between the ingestion and presentation, and type of the BZ used were extracted from the patients' charts and recorded. ECGs on presentation to the emergency department (ED) were evaluated and parameters such as PR interval, QRS duration, corrected QT, amplitude of S wave in lead I, height of R wave and R/S ratio in the lead aVR were also measured and recorded.
Results: Oxazepam, chlordiazepoxide, lorazepam, alprazolam, diazepam, and clonazepam were ingested by 9 (3%), 13 (4.4%), 29 (9.9%), 105 (35.8%), 65 (22.2%), and 72 (24.6%) patients, respectively. Mean PR interval was reported to be 0.16 ± 0.03 sec and PR interval of greater than 200 msec was detected in 12 (4.5%) patients. Mean QRS duration was 0.07 ± 0.01sec and QRS≥120 msec was observed in 7 (2.6%) cases.
Conclusion: Diazepam is the only BZ that does not cause QRS widening and oxazepam is the only one not causing PR prolongation. It can be concluded that if a patient refers with a decreased level of consciousness and accompanying signs of BZ toxicity, QRS widening in ECG rules out diazepam, whereas PR prolongation rules out oxazepam toxicity.
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The Iranian Journal of Toxicology
Arak University of Medical Sciences in collaboration with the Iranian Society of Toxicology
Website: http://ijt.arakmu.ac.ir
Email: tox.journal@gmail.com
