Fatal Seizures after Flumazenil Administration in a Patient with Mixed Overdose

Haverkos, Gregory P.; DiSalvo, Raymond P.; Imhoff, Thomas

doi:10.1177/106002809402801204

Cited by 56 publications

(16 citation statements)

References 8 publications

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“…Administration of flumazenil after a mixed overdose may unmask adverse effects of coingestants, particularly cardiotoxic agents such as TCAs leading to seizures or malignant arrhythmias. [147][148][149][150] Patients who have a history of seizures may develop uncontrolled seizures after receiving flumazenil. 151 Administration of flumazenil to patients with a history of long term benzodiazepine use can precipitate an acute withdrawal state.…”

Section: Benzodiazepinesmentioning

confidence: 99%

Acute poisoning: understanding 90% of cases in a nutshell

Greene¹,

Dargan²,

Jones³

2005

Postgraduate Medical Journal

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The acutely poisoned patient remains a common problem facing doctors working in acute medicine in the United Kingdom and worldwide. This review examines the initial management of the acutely poisoned patient. Aspects of general management are reviewed including immediate interventions, investigations, gastrointestinal decontamination techniques, use of antidotes, methods to increase poison elimination, and psychological assessment. More common and serious poisonings caused by paracetamol, salicylates, opioids, tricyclic antidepressants, selective serotonin reuptake inhibitors, benzodiazepines, non-steroidal anti-inflammatory drugs, and cocaine are discussed in detail. Specific aspects of common paediatric poisonings are reviewed.

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Section: Benzodiazepinesmentioning

confidence: 99%

Acute poisoning: understanding 90% of cases in a nutshell

Greene¹,

Dargan²,

Jones³

2005

Postgraduate Medical Journal

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“…The development of seizure clearly resulted from the administration of flumazenil in case presentation 1a: doctors might well be aware of the risks associated with flumazenil administration in coma of unknown origin, as the reversal of benzodiazepine-associated central nervous system protection may unmask an underlying physical dependence or toxic effects of coadministered drugs, most notably tricyclic antidepressants [12]. In vignette 2a, the relation between antibiotic overdosing in a patient with renal failure and the development of convulsive crisis may have been less evident.…”

Section: Discussionmentioning

confidence: 99%

"Iatrogenicity cascade": Doing harm by treating harm?

Wagner

Biollaz

Zeitlinger

et al. 2009

Wien Med Wochenschr

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An electronic survey on substance-induced epileptic crisis was conducted in order to investigate whether doctors, who recognise their own prescription errors, increase their therapeutic aggressiveness, resulting in a so-called "iatrogenicity cascade". Two pairs of clinical vignettes were constructed, in which a patient suffers from iatrogenic (original version) or non-iatrogenic (control version) epileptic crisis. Vignettes were randomised and sent to doctors at the University Hospital of Lausanne, Switzerland, at an interval of 3 weeks. The results of the present survey in the surveyed population of doctors suggest that inappropriate prescription does not increase therapeutic aggressiveness.

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“…The clinician belief that midazolam typically has a short sedation duration might additionally have created a false expectation that a patient's GCS was likely to rapidly improve. The alternative to use Flumazenil to reverse sedation is not local practice and considered high risk by most clinicians 27–30 . A strong argument could be made that these patients had an unprotected airway, 27 and that intubation was indicated.…”

Section: Discussionmentioning

confidence: 99%