A poison center's ten-year experience with flumazenil administration to acutely poisoned adults

J Emerg Med. 2012 Oct;43(4):677-82. doi: 10.1016/j.jemermed.2012.01.059. Epub 2012 Jul 4.

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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antidotes / adverse effects*
  • Antidotes / therapeutic use
  • Benzodiazepines / poisoning*
  • California
  • Confidence Intervals
  • Consciousness
  • Convulsants / poisoning*
  • Female
  • Flumazenil / adverse effects*
  • Flumazenil / therapeutic use
  • Humans
  • Hypnotics and Sedatives / poisoning*
  • Male
  • Middle Aged
  • Odds Ratio
  • Seizures / chemically induced*
  • Time Factors
  • Young Adult

Substances

  • Antidotes
  • Convulsants
  • Hypnotics and Sedatives
  • Benzodiazepines
  • Flumazenil