title: The role of flumazenil in the management of patients with acute alteration of mental status in the emergency department.
abstract: There are a few case reports which suggest that flumazenil can be used as a diagnostic tool in coma of unknown aetiology but no large scale studies have proved its efficacy and cost-effectiveness. Fifty five patients with acute alteration of mental status of unknown aetiology were enrolled prospectively during a time period of one year. Flumazenil was injected intravenously in a regimen of 0.3 mg in the first minute followed by alternate 0.2 mg, 0.3 mg doses every minute until a total dose of 1 mg was given or until the patients responded. Patients were divided into two groups based on their response to flumazenil: Group 1, responders and Group 2, non-responders. The hospital stay was shortened significantly and interventional procedures, such as CT of brain and endotracheal intubation, were rendered unnecessary in several patients in Group 1. The Group 1 patients had a more favourable outcome than that of Group 2. We concluded that flumazenil may serve as a useful tool in diagnosis and management of carefully selected patients with acute alteration of mental status.
authors.affiliation: Lotung St Mary's Hospital, Taipei, Taiwan.
authors.forename: T L
authors.initials: TL
authors.lastname: Chern
authors.forename: S C
authors.initials: SC
authors.lastname: Hu
authors.forename: C H
authors.initials: CH
authors.lastname: Lee
authors.forename: J F
authors.initials: JF
authors.lastname: Deng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003128:Coma / Q000628:therapy*; D003243:Consciousness; D004632:Emergency Medical Services; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use*; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D005442:Flumazenil