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Selected Topics: Toxicology| Volume 43, ISSUE 4, P677-682, October 2012

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

  • Allyson A. Kreshak
    Correspondence
    Reprint Address: Allyson A. Kreshak, md, Division of Medical Toxicology, Department of Emergency Medicine, University of California San Diego, 200 West Arbor Drive, Mailcode 8925, San Diego, CA 92103
    Affiliations
    Division of Medical Toxicology, University of California San Diego, San Diego, California

    Department of Emergency Medicine, University of California San Diego, San Diego, California
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  • F. Lee Cantrell
    Affiliations
    California Poison Control Center – San Diego Division, San Diego, California
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  • Richard F. Clark
    Affiliations
    Division of Medical Toxicology, University of California San Diego, San Diego, California

    Department of Emergency Medicine, University of California San Diego, San Diego, California

    California Poison Control Center – San Diego Division, San Diego, California
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  • Christian A. Tomaszewski
    Affiliations
    Division of Medical Toxicology, University of California San Diego, San Diego, California

    Department of Emergency Medicine, University of California San Diego, San Diego, California
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      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.

      Keywords

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