title: Successful flumazenil reversal of paradoxical reaction to midazolam in a child.
abstract: BACKGROUND
  Greater attention to and management of anxiety and pain in pediatric patients signifies a healthy evolution in the care of children in emergency departments (EDs). Interventions to address such distress may involve unanticipated adverse effects. Midazolam, a benzodiazepine commonly administered to children for anxiolysis, may precipitate paradoxical agitation and delirium, a rare but alarming effect that warrants prompt identification and treatment.
  
  
  METHODS
  The case presented is that of a 4-year-old girl who received oral midazolam and developed a paradoxical reaction, which was reversed successfully with flumazenil. This is the first such case report in an ED involving a child. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must stay abreast of the adverse and unintended effects of the treatments provided. The literature on benzodiazepine-induced paradoxical reactions is reviewed, and flumazenil as well as other treatment options and anxiolytic alternatives are presented.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Jackson
authors.affiliation: Coastal Pediatric Associates, Charleston, South Carolina.
authors.forename: Leigh Arden
authors.initials: LA
authors.lastname: Beck
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Losek
mesh_terms: D017109:Akathisia, Drug-Induced / Q000188:drug therapy*; D014151:Anti-Anxiety Agents / Q000009:adverse effects*; D000931:Antidotes / Q000627:therapeutic use*; D002675:Child, Preschool; D003693:Delirium / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use*; D006801:Humans; D008874:Midazolam / Q000009:adverse effects*
chemical_list: D014151:Anti-Anxiety Agents; D000931:Antidotes; D005442:Flumazenil; D008874:Midazolam
keywords: anxiolysis; flumazenil; midazolam; paradoxical reaction