Reversal of fetal benzodiazepine intoxication using flumazenil

Stahl, Matthias; Saldeen, Pia; Vinge, Ellen

doi:10.1111/j.1471-0528.1993.tb15221.x

Cited by 21 publications

(5 citation statements)

References 16 publications

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“…Bradycardia is a warning sign which may indicate severe complications even with benzodiazepines; however, we think that bradycardia in the foetus could be a sign of propranolol or benzodiazepine toxicity only if the mother had simultaneous bradycardia as a sign of severe toxicity with these medications. Flumazenil can differentiate foetal asphyxia from benzodiazepine‐induced foetal heart deceleration , but it was not effective in our case. We believe maintaining HD was the best way to keep mother and baby alive.…”

Section: Discussioncontrasting

confidence: 56%

Lithium Toxicity in a Pregnant Woman

Zamani

Paeezi

Hassanian‐Moghaddam

2017

Basic Clin Pharma Tox

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Lithium is recommended in bipolar disorder and can be accompanied by significant toxicity in pregnant women. A 25-year-old single-gestation pregnant woman (28 weeks) was referred with suspicion of lithium toxicity. Serum lithium was 2.1 meq/L. Despite conservative therapy with intravenous fluids, lithium concentration increased to 5.0 meq/L 6 hr after admission mandating an emergent haemodialysis during which foetal heart rate decreased to 90 bpm. The gynaecologist ordered termination of pregnancy while the mother was still on haemodialysis. Caesarean section was carried out, but the born baby had an apgar of 2 and died. Autopsy findings of the foetus revealed a cord blood lithium concentration of 4.8 mEq/L with no physical abnormalities. Although the foetus had the signs/symptoms of distress, continuation of haemodialysis could probably have saved it as it saved its mother's life. In lithium toxicity in a pregnant woman, it is reasonable to continue haemodialysis even with the signs and symptoms of foetal distress. In similar situations, emergency haemodialysis instead of immediate caesarean section should be considered.

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Section: Discussioncontrasting

confidence: 56%

Lithium Toxicity in a Pregnant Woman

Zamani

Paeezi

Hassanian‐Moghaddam

2017

Basic Clin Pharma Tox

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“…A benzodiazepine antagonist, flumazenil, has been used with some success in such cases. 47 Withdrawal syndrome: True physiologic addiction may occur. If diazepam is tapered too rapidly or discontinued abruptly, withdrawal symptoms may appear.…”

Section: Adverse Effectsmentioning

confidence: 99%

Traditional pharmacological treatments for spasticity part II: General and regional treatments

Graciès¹,

Nance²,

Elovic³

et al. 1997

Muscle Nerve

184

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“…It is classified by the FDA as a pregnancy category C drug [27]. While many cases of benzodiazepine toxicity may be treated supportively, in a case report of maternal diazepam overdose, cardiac rhythm abnormalities in the fetus were reversed by flumazenil and the infant was born healthy 2 weeks later [28].…”

Section: Discussionmentioning

confidence: 99%

Acute Poisoning During Pregnancy: Observations from the Toxicology Investigators Consortium

et al. 2015

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Acute poisonings during pregnancy pose a particular challenge to health care providers because of the potential for an immediate life threat or possible life-long implications for both the mother and fetus, including teratogenicity of the poison or its antidote. We describe recent consequential exposures among pregnant women in the USA. We identified all poisoning cases involving pregnant women that were catalogued by the medical toxicology services across the 37 sites of the Toxicology Investigators Consortium (ToxIC) Registry of the American College of Medical Toxicology between January 2010 and December 2012. Of 17,529 exposure cases reported in the ToxIC Registry, 103 (0.6 %) involved pregnant women, 80 % of whom were symptomatic and about a quarter displayed a specific toxidrome. The majority of cases (n = 53; 51.5 %) involved intentional exposures, most commonly to pharmaceutical agents, followed by unintentional pharmaceutical exposures (10 %) and withdrawal syndromes (9 %). Non-opioid analgesics were the most common class of agents encountered (31 %), followed by sedative-hypnotics/muscle relaxants (18 %), opioids (17 %), anti-convulsants (10 %), and anti-depressants (10 %). Over a third of cases involved exposure to multiple substances, and 32 % involved exposure to more than one drug class. The most commonly administered antidotes were N-acetylcysteine (23 %), sodium bicarbonate (10 %), flumazenil (4 %), and physostigmine (4 %). About half of acute poisoning cases among pregnant women presenting for emergency care involved intentional exposures, mostly with over-the-counter analgesics and psychoactive medications. Clinicians should be cognizant of the unique circumstances, maternal and fetal risks, and management principles of the acutely poisoned pregnant woman.

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Reversal of fetal benzodiazepine intoxication using flumazenil

Cited by 21 publications

References 16 publications

Lithium Toxicity in a Pregnant Woman

Lithium Toxicity in a Pregnant Woman

Traditional pharmacological treatments for spasticity part II: General and regional treatments

Acute Poisoning During Pregnancy: Observations from the Toxicology Investigators Consortium

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