Benzodiazepine overdose in a patient presenting with coma, is treated by: March 2010

Ans. B: Flumazenil Decontamination - Gastric lavage is not recommended but may be considered if the presence of a lethal co-ingestant is suspected and the patient presents within 1 hour of ingestion. - Single-dose activated charcoal is recommended for GI decontamination in patients with protected airway who present within 4 hours of ingestion. Respiratory depression may be treated with assisted ventilation. Flumazenil - Flumazenil is a competitive BZD receptor antagonist and should be used cautiously because it has potential to precipitate BZD withdrawal in chronic users, resulting in seizures. - Flumazenil administration is contraindicated in mixed overdoses (e.g., TCAs) because BZD reversal can precipitate seizures and cardiac arrhythmias. - Ideal indication for flumazenil use is isolated BZD overdose, paicularly if overdose is iatrogenic in nature.