Lack of adverse effects from flumazenil administration: an ED observational study.
BACKGROUND
Flumazenil is an effective benzodiazepine (BZD) antagonist. Empiric use of flumazenil in the emergency department (ED) is not widely recommended due to concerns of seizures, which are commonly associated with coingestants and BZD withdrawal.


OBJECTIVE
The objective of the study is to assess adverse events and clinical outcomes of flumazenil administration in known and suspected BZD overdose in an ED at a tertiary academic medical center.


METHODS
This is a retrospective observational study of adult patients administered flumazenil for known or suspected BZD overdose in the ED over 7 years. Outcomes included mental status improvement, the incidence of seizures, and intubation of the trachea after flumazenil administration.


RESULTS
Twenty-three patients were included in the analysis, of which 15 (65%) of patients experienced some type of clinically significant mental status improvement. No seizures were identified despite 7 (35%) reported proconvulsant coingestants. One patient required intubation of the trachea but was subsequently extubated in the ED.


CONCLUSIONS
A majority of patients had improved mental status after the administration of flumazenil. No patient experienced seizures. Additional studies that clarify the role of flumazenil for ED patients with suspected BZD toxicity are warranted.
Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298; Virginia Poison Center, Richmond, VA 23298; Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298. Electronic address: TammyNguyenT@gmail.com.
Tammy T
TT
Nguyen
Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298; Virginia Poison Center, Richmond, VA 23298; Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298.
Michelle
M
Troendle
Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298; Virginia Poison Center, Richmond, VA 23298; Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298.
Kirk
K
Cumpston
Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298; Virginia Poison Center, Richmond, VA 23298; Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298.
S Rutherfoord
SR
Rose
Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298; Virginia Poison Center, Richmond, VA 23298; Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298.
Brandon K
BK
Wills
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000931:Antidotes / Q000009:adverse effects*; D001569:Benzodiazepines / Q000506:poisoning*; D062787:Drug Overdose / Q000188:drug therapy*; D004636:Emergency Service, Hospital; D005260:Female; D005442:Flumazenil / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000931:Antidotes; D001569:Benzodiazepines; D005442:Flumazenil