A Poison Center's Ten-year Experience with Flumazenil Administration to Acutely Poisoned Adults

• Published in: The Journal of emergency medicine Vol. 43; no. 4; pp. 677 - 682
• Main Authors: Kreshak, Allyson A., MD, Cantrell, F. Lee, PharmD, Clark, Richard F., MD, Tomaszewski, Christian A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2012
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; antidote; Antidotes - adverse effects; Antidotes - therapeutic use; benzodiazepine; Benzodiazepines - poisoning; California; Confidence Intervals; Consciousness; Convulsants - poisoning; Emergency; Female; flumazenil; Flumazenil - adverse effects; Flumazenil - therapeutic use; Humans; Hypnotics and Sedatives - poisoning; Male; Middle Aged; Odds Ratio; poisoning; seizures; Seizures - chemically induced; Time Factors; Young Adult; California; seizures; poisoning; flumazenil; antidote; benzodiazepine
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2012.01.059

Abstract Background The frequency of seizures among acutely poisoned adults who are administered flumazenil has not been well established. Study Objective The objectives of the study were: to determine the frequency of seizures among acutely poisoned adults administered flumazenil; to identify factors associated with seizures; and to determine the mental status of subjects before and after administration of flumazenil. Methods This study was a historical case series of acutely poisoned adults reported to a poison control system from 1999 to 2008. Included cases were those involving administration of flumazenil to subjects who were ≥ 18 years of age. Both genders were included. Variables collected included: presence of seizure or death, exposure to a pro-convulsant drug, and mental status before and after flumazenil administration. Results Over the 10-year period studied, 904 cases were identified that met inclusion criteria. Thirteen subjects (1.4%) developed seizures after flumazenil was administered. One death occurred. There were 293 subjects exposed to a pro-convulsant drug, and 8 of these had seizures after flumazenil administration. Development of seizures after flumazenil administration was significantly associated with exposure to a pro-convulsant drug (odds ratio 3.41; 95% confidence interval 1.13–10.72). Mental status before and after flumazenil administration was available for 546 subjects (60.3%). Of these, 291 (53.3%) became awake after administration of flumazenil. Conclusions Flumazenil administration to acutely poisoned adults resulted in a low frequency of seizures and death. Development of seizures was associated with exposure to a pro-convulsant drug. More than half of the subjects for whom mental status was recorded became awake after receiving flumazenil.