What question did this study set out to answer?

To elucidate the challenges in managing prolonged consciousness impairment following a mixed drug overdose in individuals with comorbidities.

May 31, 2026

Prolonged and fluctuating consciousness after mixed overdose: navigating the complexities of polypharmacy, hepatic impairment and flumazenil use

Key Points

To elucidate the challenges in managing prolonged consciousness impairment following a mixed drug overdose in individuals with comorbidities.
Case report of a male in his 50s with reduced consciousness and comorbidities after mixed drug overdose.
Investigated the effects of flumazenil, monitored Glasgow Coma Scale (GCS), and assessed liver function.
Evaluated the patient's condition using CT head, electroencephalogram (EEG), and metabolic assessments.
Flumazenil produced temporary improvement in GCS from 11, yet fluctuating consciousness and further decline were noted.
Post-treatment assessments revealed hyperammonaemia and mild diffuse encephalopathy.
Synergistic effects of polypharmacy and liver dysfunction likely contributed to persistent altered consciousness.

Abstract

Mixed drug overdose presents a complex and potentially unpredictable clinical course, particularly in the presence of comorbidities that may alter drug metabolism, half-life and pharmacodynamic effects. We report a man in his 50s presenting with reduced consciousness, Glasgow Coma Scale (GCS) 11, requiring oxygen therapy after ingesting 100 mg diazepam, 1200 mg pregabalin and suspected co-ingestion of zopiclone and gabapentin. Flumazenil produced rapid but transient improvement. However, fluctuating consciousness persisted, with further deterioration in GCS on day 8 that again responded to flumazenil. He had liver fibrosis and a raised body mass index (33 kg/m²). Investigations revealed hyperammonaemia, mild diffuse encephalopathy on electroencephalogram (EEG) and faecal retention. CT head was unremarkable. The prolonged clinical course was likely multifactorial, reflecting synergistic central nervous system depressant effects in the context of polypharmacy, hepatic dysfunction, hyperammonaemia and obesity. This case highlights the importance of recognising mixed overdose and comorbid modifiers in prolonged complex toxic presentations.

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