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Benzodiazepine (BZD) overdose is a serious public health issue with an exponentially rising incidence.1 More recently non-Food and Drug Administration approved BZDs has been made available through internet-shops making these highly potent substances easily accessible.2 In this report, we present a case of a patient admitted after Diclazepam overdose, a designer BZD purchased online.

buy diclazepam drug online His initial vital signs showed a blood pressure of 80/44 mmHg, heart rate of 67/min, respiratory rate of 18/min, temperature of 36.2°C and oxygen saturation of 97% on a non-rebreather. His pertinent examination showed a Glasgow Coma Scale of 3 with absent cough, gag and corneal reflexes. His pupils were dilated and non-reactive to light. He was intubated and started on mechanical ventilation.

After 48 h, there was no neurological improvement so additional work up was performed. Electroencephalogram showed a lack of physiologic rhythms and the presence of burst attenuations suggestive of significant intracranial pathology secondary to toxic-metabolic, ischemic or infectious etiology. Magnetic resonance imaging of the brain showed bilateral restricted hippocampal defects suggesting mild hypoxic brain injury.

After 72 h, the patient started to show evidence of neurological recovery with the return of a cough and gag reflex. Over the next few days, his neurological examination continued to slowly improve. His hospital course was complicated by extreme agitation and withdrawal symptoms that were managed with antipsychotics and short-acting BZDs. Ten days after the presentation he was successfully extubated and reported ingestion of Diclazepam that he had purchased

buy diclazepam drug online designer BZD are not detectable with standard drug screens, they may give a negative result despite acute intoxication and the metabolites of Diclazepam such as Lorazepam, may not be detectable in an early presentation. Our patient tested positive on the BZD screen and confirmatory tests were positive for Lorazepam only. Flumazenil, a competitive antagonist of BZDs is sometimes used to reverse general anesthesia, procedural sedation and can be considered in suspected BZD overdose. However, its role is controversial in patients with chronic BZDs use or in multidrug overdose cases as it can precipitate seizures. Since we did not know the chronicity of our patient’s drug abuse and the specific product he had ingested, we decided against empirically giving flumazenil.

buy diclazepam drug online of its low cost and easy availability, physicians could be seeing an upsurge in designer BZD toxicities in the coming years. As of 2016, there were at least 55 websites worldwide that sold Diclazepam, the majority of which were based in Europe.3 It has also been found in illicit drugs labeled as Diazepam, along with other BZDs and opioids,4 and has been reported in at least one drug-facilitated sexual assault in China.5

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