Non-fatal overdose following ingestion of encapsulated pure bromazolam powder: A case report

Bromazolam is a potent designer benzodiazepine increasingly encountered in forensic and clinical toxicology. Here, a case of non-fatal intoxication involving the ingestion of encapsulated pure bromazolam powder is reported, and, to our knowledge, it resulted in the highest documented bromazolam serum concentration to date. A healthy 20-year-old male was found unresponsive at home and admitted to intensive care. Toxicology confirmed bromazolam as the primary intoxicant, with an initial serum concentration exceeding 5800 ng/mL. The patient required prolonged intubation, and sedation persisted for over ten days despite supportive care and flumazenil administration. Five serum samples collected over 204 h showed declining bromazolam concentrations with an estimated half-life of 31 h. Analytical testing of seized powder at the scene confirmed pure bromazolam content, supporting the conclusion of high-dose exposure. Serum samples were diluted to fit within the method’s linear range, and dilution integrity testing demonstrated accurate bromazolam quantification at these levels. This case underscores the severe toxicological effects of ingesting pure bromazolam, the importance of timely toxicological confirmation in clinical decision-making, and the need for methods to identify novel substances and quantify high-concentration samples. Serum concentration decline and key interventions during bromazolam overdose hospitalization. • Bromazolam overdose with high serum levels and prolonged ventilator treatment. • Five serum samples analysed over 204-hour period. • Seized powder confirmed as pure bromazolam by instrumental analysis. • Bromazolam still detectable in serum 10 days after ingestion.