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Flumazenil Administration in Poisoned Pediatric Patients

Kreshak, Allyson A. MD*; Tomaszewski, Christian A. MD*; Clark, Richard F. MD*†; Cantrell, F. Lee PharmD*†

doi: 10.1097/PEC.0b013e3182531d0d
Original Articles

Objective The goal of this retrospective cohort study of pediatric patients exposed to flumazenil was to identify the frequency of seizures.

Methods Included patient were those aged 12 years or younger who received flumazenil, who had evidence of clinical poisoning as defined by an altered mental status, and who were reported to the California Poison Control System for the period 1999 to 2008. Data variables were age, sex, seizure, death, acute exposure to a benzodiazepine, drugs of exposure, long-term use of benzodiazepines, history of a seizure disorder, mental status before flumazenil administration, and poison center recommendation of flumazenil (yes/no).

Results Eighty-three patients were included. Forty-eight (58%) of this subset were female. Median age was 2 years (range, 3 months–12 years). Seventy (84%) patients were younger than 5 years. Of the 83 patients, 68 (82%) were allegedly exposed to a benzodiazepine; whereas, 12 (15%) had been allegedly exposed to a proconvulsant drug. No flumazenil-related seizures occurred (0% with 95% confidence interval, 0%–4%). The California Poison Control System recommended flumazenil use in 60 (72%) of the 83 cases, and 48 of these had been allegedly exposed to a benzodiazepine.

Conclusions No flumazenil-associated seizures occurred among allegedly benzodiazepine- and non–benzodiazepine-poisoned pediatric patients aged 12 years or younger.

From the *Division of Medical Toxicology, Department of Emergency Medicine, University of California San Diego; and †California Poison Control System, San Diego Division, San Diego, CA.

Disclosure: The authors declare no conflict of interest.

Reprints: Allyson A. Kreshak, MD, Division of Medical Toxicology, Department of Emergency Medicine, University of California San Diego, 200 West Arbor Dr, Mailcode 8925, San Diego, CA 92103 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.