Benzo dosing and pharmacology has always been confusing to me. Here are some tidbits and pearls that stick with me:
Our very own fabulous Dr. Reuben Strayer’s IV to IM conversion of commonly utilized benzodiazepines. As he notes as well, conversions are more of an art than a science.
PO conversion: 1 mg lorazepam = 10 mg diazepam = 25mg chlordiazepoxide (librium)
Short acting: midazolam, alprazolam/xanax
Medium acting: lorazepam, clonazepam/klonopin
Long acting: diazepam, librium
IM midazolam, not IM lorazepam. Lorazepam’s intramuscular absorption is erratic/slower and it is longer acting than versed.
Lorazepam is not a code white medication.
10mg IM midazolam -> this patient goes to resus at least initially. This is an increasingly common dose for someone to receive by pre-hospital.
Be wary of ETOH + benzos, these are extremely high risk patients.
The treatment of severe ETOH withdrawl/DT's requires probably an uncomfortable amount of benzos.