A case of suicide attempt with Zolpidem - will Zolpidem show up on standard urine toxicology screening?

We describe a case of deep stupor after a suicide attempt with Zolpidem (Stillnox). A 64 year old patient was admitted unconscious to the emergency room. According to the medical document brought by his family, the patient was recently diagnosed with APLA syndrome, had 2 previous CVAs, the last one, having been located in the occipital lobe, resulted in cortical blindness. His wife described short-term memory deterioration, loss of appetite and a depressed mood over the last few months. A week before his current admission the patient was hospitalized in the neurology ward suffering from confusion and memory loss; had a brain CT and EEG done, and his Depalept dosage was increased. Aspirin and Warfarin. The ambulance crew reported finding the patient unconscious in his bedroom with empty packages of unknown drugs scattered around him. On admission to the ER, the patient showed hemodynamic and respiratory stability; vital signs were normal, level of consciousness was defined as a stupor or a coma (GCS – 6). Physical examination was normal, neurological examination revealed pain positioning bilaterally, pupils responsive to light, general hypotonus and a positive Babinski sign in the right leg. Nuchal rigidity was not observed. Complete blood test, full chemistry including electrolytes, blood gases and valporic acid levels were all non-remarkable. Gastric lavage revealed no drugs or any other offending substances. Chest X-ray and ECG were normal. The patient showed no response to Naloxon administration. During the night the patient remained in a stupor most of the time, but reacted to Flumazenil administration with short lucid intervals. The first urine toxicology screening, sent for the patient approximately 3 h after estimated time of ingestion of the drug, was found negative for any offending substances including benzodiazepines. The second test, performed in the morning, approximately 20 h after estimated time of ingestion, showed a positive weak result for PCP (phencyclidine). By that time the patient had fully recovered and was able to confess to his suicide attempt by ingestion of around 40 pills of 5 mg Zolpidem (Stillnox). The patient explained in detail the reasons for his actions and asked for psychiatric assistance. During the next few days the