Hazards of administration of benzodiazepines in patients with adaptive hyperventilation: a case rapport
Introduction Only three population-based observational human studies provided evidence that benzodiazepines (BZD) are associated with clinically adverse respiratory outcome. Striking was the finding that BZD drug exposure was associated with a 32% significantly increased adjusted risk of all-cause...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-06-01
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| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933822015048/type/journal_article |
| _version_ | 1827753530343030784 |
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| author | S. Petrykiv M. Arts L. De Jonge |
| author_facet | S. Petrykiv M. Arts L. De Jonge |
| author_sort | S. Petrykiv |
| collection | DOAJ |
| description |
Introduction
Only three population-based observational human studies provided evidence that benzodiazepines (BZD) are associated with clinically adverse respiratory outcome. Striking was the finding that BZD drug exposure was associated with a 32% significantly increased adjusted risk of all-cause mortality, including, of note, the subgroup of individuals with no comorbidities. Causation, however, cannot be inferred in observational study design and, highly likely, recipients received BZD’s in these studies to help treating anxiety related to inter alia pre-existing respiratory symptoms.
Objectives
Based on one fatal particular case, authors of current rapport explain what can go wrong when BZD’s are given in patient with respiratory impairment.
Methods
Authors provide a model on how an increase in carbon dioxide can lead to impaired cerebral autoregulation in a person with pre-existing respiratory decompensation. Discussion of integrative metabolic and vascular physiology.
Results
Case rapport of a 18 y.o. otherwise healthy man, who was hospitalized with a novel episode of diabetic ketoacidosis accompanied by profound hypocapnia and anxiety, and who deteriorated and died shortly after airway management because of a clinically important acid-base balance disturbance caused by increased carbon dioxide. All the blood tests and results of respiratory monitoring were collected and carefully assessed.
Conclusions
Current case suggests that the P(CO(2))--HCO(3) hypothesis is consistent with known data on impaired cerebral autoregulation in diabetic ketoacidosis, driven mainly by increased levels of pCO2. In our opinion, it indicates the recommendation not to administrate BZD’s in patients with pre-existing compensatory hyperventilation as it may counter to the logic of adaptive physiology.
Disclosure
No significant relationships.
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| first_indexed | 2024-03-11T07:36:30Z |
| format | Article |
| id | doaj.art-05159131b3ba40ba90a1ebea20010d95 |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:36:30Z |
| publishDate | 2022-06-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-05159131b3ba40ba90a1ebea20010d952023-11-17T05:09:19ZengCambridge University PressEuropean Psychiatry0924-93381778-35852022-06-0165S587S58710.1192/j.eurpsy.2022.1504Hazards of administration of benzodiazepines in patients with adaptive hyperventilation: a case rapportS. Petrykiv0M. Arts1L. De Jonge2GGZWNB, Psychiatry, Halsteren, NetherlandsGGZWNB, Psychiatry, Bergen op Zoom, NetherlandsLeonardo Scientific Research Institute, Neuropsychiatry, Bergen op Zoom, Netherlands Introduction Only three population-based observational human studies provided evidence that benzodiazepines (BZD) are associated with clinically adverse respiratory outcome. Striking was the finding that BZD drug exposure was associated with a 32% significantly increased adjusted risk of all-cause mortality, including, of note, the subgroup of individuals with no comorbidities. Causation, however, cannot be inferred in observational study design and, highly likely, recipients received BZD’s in these studies to help treating anxiety related to inter alia pre-existing respiratory symptoms. Objectives Based on one fatal particular case, authors of current rapport explain what can go wrong when BZD’s are given in patient with respiratory impairment. Methods Authors provide a model on how an increase in carbon dioxide can lead to impaired cerebral autoregulation in a person with pre-existing respiratory decompensation. Discussion of integrative metabolic and vascular physiology. Results Case rapport of a 18 y.o. otherwise healthy man, who was hospitalized with a novel episode of diabetic ketoacidosis accompanied by profound hypocapnia and anxiety, and who deteriorated and died shortly after airway management because of a clinically important acid-base balance disturbance caused by increased carbon dioxide. All the blood tests and results of respiratory monitoring were collected and carefully assessed. Conclusions Current case suggests that the P(CO(2))--HCO(3) hypothesis is consistent with known data on impaired cerebral autoregulation in diabetic ketoacidosis, driven mainly by increased levels of pCO2. In our opinion, it indicates the recommendation not to administrate BZD’s in patients with pre-existing compensatory hyperventilation as it may counter to the logic of adaptive physiology. Disclosure No significant relationships. https://www.cambridge.org/core/product/identifier/S0924933822015048/type/journal_articleBenzodiazepinesHypoventilationCase rapportTreatment |
| spellingShingle | S. Petrykiv M. Arts L. De Jonge Hazards of administration of benzodiazepines in patients with adaptive hyperventilation: a case rapport European Psychiatry Benzodiazepines Hypoventilation Case rapport Treatment |
| title | Hazards of administration of benzodiazepines in patients with adaptive hyperventilation: a case rapport |
| title_full | Hazards of administration of benzodiazepines in patients with adaptive hyperventilation: a case rapport |
| title_fullStr | Hazards of administration of benzodiazepines in patients with adaptive hyperventilation: a case rapport |
| title_full_unstemmed | Hazards of administration of benzodiazepines in patients with adaptive hyperventilation: a case rapport |
| title_short | Hazards of administration of benzodiazepines in patients with adaptive hyperventilation: a case rapport |
| title_sort | hazards of administration of benzodiazepines in patients with adaptive hyperventilation a case rapport |
| topic | Benzodiazepines Hypoventilation Case rapport Treatment |
| url | https://www.cambridge.org/core/product/identifier/S0924933822015048/type/journal_article |
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