PROTRACTED COURSE OF BROMAZEPAM POISONING IN AN ELDERLY WOMAN

History and clinical findings: A 68-year-old woman was found unconscio us and hardly breathing. Artificial ventilation was undertaken by an e mergency physician who brought her to hospital. Physical examination p rovided no evidence of relevant organ abnormalities. Neurological exam ination of the comatose patient revealed absent brain-stem reflexes an d spontaneous respiration. But no other focal neurological abnormaliti es were found. Investigations: Routine laboratory tests, EGG, chest ra diogram, Doppler sonography of arteries to the brain, lumbar cerebrosp inal fluid and computed tomography of the skull were unremarkable. Tox icological tests discovered bromazepam intoxication (serum level 6 mg/ l; maximal serum level after intake of 6 mg of the active consatituent : 0.1 mg/dl). Diagnosis, treatment and course: When bromazepam poisoni ng was demonstrated elimination of the drug was no longer feasible; th e spontaneous course of the poisoning with slowly falling drug levels could thus be observed over 10 days. In parallel with the fall of brom azepam concentration in blood, restitution of breathing and of brain-s tem reflexes was recorded until, 12 days after intake of the drug, nor mal functions had been restored. Conclusion: Central respiratory arres t occurred at a bromazepam serum level of 6 mg/l. Without intensive me dical care the patient would not have survived.