A 7-year-old boy is brought to the emergency department by his older sister after being found in their mother's bathroom with an open bottle of pills. The bottle is unlabeled and the boy is unable to describe how many pills he ingested. The sister, who was babysitting, became alarmed when the boy subsequently became increasingly lethargic over the next hour. The mother takes medications for anxiety, depression, and chronic lower back pain. On arrival, the boy is somnolent and difficult to arouse. Temperature is 36.7 C (98 F), blood pressure is 100/60 mm Hg, pulse is 75/min, and respirations are 16/min. Physical examination is unremarkable. Which of the following drugs is most likely to reverse this patient's symptoms?

Question

A 7-year-old boy is brought to the emergency department by his older sister after being found in their mother's bathroom with an open bottle of pills.  The bottle is unlabeled and the boy is unable to describe how many pills he ingested.  The sister, who was babysitting, became alarmed when the boy subsequently became increasingly lethargic over the next hour.  The mother takes medications for anxiety, depression, and chronic lower back pain.  On arrival, the boy is somnolent and difficult to arouse.  Temperature is 36.7 C (98 F), blood pressure is 100/60 mm Hg, pulse is 75/min, and respirations are 16/min.  Physical examination is unremarkable.  Which of the following drugs is most likely to reverse this patient's symptoms?

Quizplus · Accepted Answer

11ec160b_3c3e_74df_9249_abe01f6e27f8_MD0001_00 The presence of sedation with normal vital signs for age and an unremarkable physical examination is most consistent with benzodiazepine overdose. Benzodiazepines are often used in the treatment of anxiety disorders and alcohol withdrawal, as well as for procedural sedation. They bind as agonists at the benzodiazepine site on the GABA_A receptor to potentiate the inhibitory effects of GABA, the major inhibitory neurotransmitter of the central nervous system. Flumazenil functions as a competitive antagonist at the benzodiazepine binding site and may be used as an antidote to reverse benzodiazepine sedation related to overdose or procedural sedation. (Choice A) Cyproheptadine is a serotonin antagonist that has been used to treat severe cases of serotonin syndrome. Serotonin syndrome is characterized by altered mental status, autonomic hyperactivity (eg, tachycardia, hypertension), and hyperreflexia/myoclonus. (Choice B) Diphenhydramine is an antihistamine that has been used to treat allergies and insomnia and to reverse antipsychotic drug-induced dystonic reactions. (Choice D) Naloxone is an opioid antagonist that is indicated in patients with suspected opioid overdose (eg, decreased respiratory rate, miosis). Opioid overdose is unlikely in this patient with age-appropriate normal vital signs. (Choice E) Physostigmine is an acetylcholinesterase inhibitor that has been used as an antidote in severe cases of anticholinergic toxicity (dry mouth, mydriasis, tachycardia). Educational objective: Flumazenil is a benzodiazepine receptor antagonist. It can reverse the sedative effects of benzodiazepines related to overdose and procedural sedation. __________ References: Flumazenil, naloxone and the 'coma cocktail.' (http://www.ncbi.nlm.nih.gov/pubmed/26469689)

A 7-Year-Old Boy Is Brought to the Emergency Department by His