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Tox Dogmalysis
Bryan D. Hayes@PharmERToxGuy
Acad Emerg Med 1997;19(4):935-6.
A poison center’s ten-year experience with flumazenil administration to acutely poisoned
adults.
Kreshak AA, et al. J Emerg Med 2012;43(4):677-82.
904 pts
13 seizures
1 death
Flumazenil administration in poisoned pediatric patients.
Kreshak AA, et al. Pediatr Emerg Care 2012;28(5):448-50.
83 pts
0 seizures
0 deaths
Flumazenil use in benzodiazepine overdose in the UK: a retrospective survey of NPIS data.
Veiraiah A, et al. Emerg Med J 2012;29(7):565-9.
80 pts
1 seizure
0 deaths
RISK
BENEFIT
+ Beta-Blockers
Citation Design Outcome FlawsMohamad 2008 Retrospective, observational
(n = 364) - Utox
Dattilo 2008 Retrospective cohort (n = 363) + Utox
Hoskins 2010 Prospective, open label (n = 90) =
Rangel 2010 Retrospective cohort (n = 331) = Utox
Ibrahim 2013 Retrospective cohort (n = 387) = Utox
Fanari 2014 Retrospective cohort (n = 376) = Utox
Gupta 2014 Retrospective cohort, registry (n = 924) = Utox
Citation Design Outcome FlawsMohamad 2008 Retrospective, observational
(n = 364) - Utox
Dattilo 2008 Retrospective cohort (n = 363) + Utox
Hoskins 2010 Prospective, open label (n = 90) =
Rangel 2010 Retrospective cohort (n = 331) = Utox
Ibrahim 2013 Retrospective cohort (n = 387) = Utox
Fanari 2014 Retrospective cohort (n = 376) = Utox
Gupta 2014 Retrospective cohort, registry (n = 924) = Utox
The effects of IV calcium in patients with digoxin toxicity.
Levine M, et al. J Emerg Med 2011;40(1):41-6.
Calcium
5 deaths (22%)
0 dysrhythmias
No calcium
27 deaths (20%)
Outline - Flumazenil use in benzo poisoning (http://www.ncbi.nlm.nih.gov/pubmed/21053379,
http://www.ncbi.nlm.nih.gov/pubmed/22531190, http://www.ncbi.nlm.nih.gov/pubmed/21785147) 15920864 8644960 15214628 1286503 & 1611650 http://empharmd.blogspot.com/2013/11/flumazenil-friend-or-foe.html 8605789 22766408 http://www.thepoisonreview.com/2012/07/26/flumazenil-induced-seizures/ http://www.thepoisonreview.com/2012/05/08/is-use-of-flumazenil-in-poisoned-pediatric-patients-safe/
- Beta blockers in cocaine chest pain (Rangel C, et al. Arch Intern Med 2010;170:874-9) (Mohamad T, et al. Am J Ther 2008;15:531-5) (Dattilo PB, et al. Ann Emerg Med 2008;51:117-25) 23122421 + http://www.emlitofnote.com/2012/11/dont-blockade-cocaine-chest-pain.html
- Calcium use in digoxin poisoning (http://www.ncbi.nlm.nih.gov/pubmed/19201134, http://www.ncbi.nlm.nih.gov/pubmed/15461240) Bower JO. JAMA 1936;106-1151-3 Kne T. J Toxicol Clin Toxicol 1997;5:505 (abstract) http://www.thepoisonreview.com/2011/01/29/heart-of-stone-calcium-and-digoxin-toxicity/ http://lifeinthefastlane.com/education/ccc/calcium-digoxin-toxicity-and-stone-heart-theory/
ObjectivesGiven a patient with digoxin or cocaine toxicity,
appraise the historical controversies of using calcium or beta blockers, respectively, in these settings.
In a patient with benzodiazepine poisoning, determine when it is appropriate to administer flumazenil.
