Is the flumazenil administration diagnosis or treatment? Two case reports

Year 2013, Volume: 30 Issue: 4, - , 06.02.2014

Türker Yardan Ethem Acar , Hızır Akdemır Ahmet Baydın , Latif Duran

Abstract

Benzodiazepine has the central nervous system (CNS), cardiac and respiratory side effects when intaked more than therapeutic doses. Acute benzodiazepine poisoning may be manifest taken in the form of dizziness, ataxia, nystagmus, dysarthria, hypoxia, hypothermia, hypotension, bradycardia, apnea, pulmonary aspiration, respiratory depression, coma, cardiopulmonary arrest and death. Alprazolam is the most toxic form of benzodiazepines and unless combined with the other CNS depressants such as barbiturates and alcohol, death is rare. When benzodiazepine intoxication is suspected, the next step is flumazenil administration to reverse the CNS and respiratory system depression. In this case report, we aimed to point to the diagnosis and treatment of benzodiazepine intoxications by representing two intoxicated patients with
coma.

J. Exp. Clin. Med., 2013; 30:395-397

Keywords

Benzodiazepine; emergency; flumazenil; intoxication

References

• Guadreault, P., Guay, J., Thivierge, R.L., Verdy, L., 1991. Benzodiazepine poisoning: Clinical and pharmacologic considerations and treatment. Drug Safety. 6, 247-265.
• Güloglu, C., and Söğüt, Ö., 2004. Özkıyım amaçlı yüksek doz alprazolam entoksikasyonu, Dicle Tıp Derg. 31, 69-73.
• Hung, D.Z., Tsai, W.J., Deng, J.F., 1992. Anterograde amnesia in triazolam overdose despite flumazenil treatment: A case report. Hum. Exp. Toxicol. 11, 289-90.
• Koski, A., Ojanperä, I., Vuori, E. 2003. Interaction of alcohol and drugs in fatal poisonings. Hum. Exp. Toxicol. 22, 281-287.
• Michaud, K., Augsburger, M., Giroud, C., Mangin, P. 1999. Fatal overdose of tramadol and alprazolam. Forensic Sci. Int. 105, 185-189. Ramadan, M.I., Werder, S.F., Preskorn, S.H. 2006. Protect against drug-drug interactions with anxiolyticts. Curr. Psychiatr. 5, 16-28.
• Ritz, R., Zuber, M., Elsasser, S., Scollo-Lavizzari, G., 1990. Use of flumazenil in intoxicated patients with coma. Intensive Care Med. 16, 2422
• Seger, D.L., 2004. Flumazenil-treatment or toxin. J. Toxicol. Clin. Toxicol. 42, 209-216
• Tunçok, Y., Kalyoncu, N.I., (ed.) 2007. T.C. Sağlık Bakanlığı Birinci Basamağa Yönelik Zehirlenmeler Tanı ve Tedavi Rehberleri SB, RSHMB. Hıfzısıhha Mektebi Müdürlüğü. 14, 79-82.
• Weinbroum, A., Rudick, V., Sorkine, P., Nevo, Y., Halpern, P., Geller, E., Niv, D. 1996. Use of flumazenil in the treatment of drug overdose: A double-blind and open clinical study in 110 patients. Crit. Care Med. 24, 199-206.
• Welch, T.R., Rumack, B.H., Hammond, K., 1977. Clonazepam overdose resulting in cyclic coma. Clin. Toxicol. 10, 433-436.