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Benzodiazepines were found in the serum in 36 of the 53 patients in the flumazenil group and in 37 of the 52 who received placebo.The average coma scale score increased significantly after injection in the flumazenil group(6-4 v 12-1,p<0.001)but not in the placebo group.In the flumazenil group several interventions were rendered unnecessary by the injection: gastric lavage and urinary catheterisation(19 patients each),intubation (21),artificial ventilation and computed tomography of the brain(three patients each),blood culture and lumbar puncture(one patient each),and electroencephalography(two).In the placebo group the indications for these procedures did not change in any patient after injection.The 95%confidence interval for the difference in reduction of the frequency of indications for gastric lavage after injection between the two groups was 21%to 51%, that for intubation 25%to 55%,and that for urinary catheterisation 21%to 51%.In the flumazenil group 21 patients gave valuable information on their drug ingestion within 10 minutes after injection compared with only one in the placebo group(p<0.001).Nine adverse reactions were recorded in the flumazenil group,eight of which were graded as mild and one severe.The safety of the antagonist was acceptable,even though 60%of the patients in the flumazenil group had multiple drug poisoning including benzodiazepine. No epileptic seizures or arrhythmias were recorded.Conclusion:Flumazenil is a valuable and safe differential diagnostic tool in unclear cases of multiple drug poisoning. |
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adverse drug reaction
benzodiazepine
benzodiazepine antagonist
coma
coma,management of
drug abuse,diagnostic studies
drug overdose
drug overdose,management of
flumazenil
treatment of neurologic disorder
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