Death from sedative-hypnotics results from respiratory arrest. The physical exam should focus on the vital signs and the neurologic and cardiopulmonary status. Mild toxicity resembles ethanol intoxication. Severe respiratory depression is more likely to occur when the sedative-hypnotic is ingested with other CNS depressants. Mild intoxication is characterized by ataxia, incoordination, nystagmus, slurred speech and altered level of consciousness.
Moderate poisoning leads to respiratory depression and hyporeflexia.
Severe poisoning leads to flaccid, areflexic coma, apnea, and hypotension. Occasionally, hyperreflexia, rigidity, clonus and Babinski signs are present. Miosis is common, but mydriasis may be present with certain agents. The non-barbiturates, such as methyprylon and glutethimide more commonly present with mydriasis. Hypotension is usually secondary to venodilation and negative cardiac inotropic effects.