A 24-year-old woman is brought to the emergency department after ingesting an unknown overdose. She is drowsy but rousable with hypotonia and diminished reflexes. The emergency physician suspects benzodiazepine overdose but decides to avoid flumazenil. The most important reason to withhold flumazenil in a mixed overdose is the risk of precipitating:

• A Severe hypertension
• B Acute liver failure
• C Seizures ✓
• D Respiratory arrest

Explanation

Flumazenil is a competitive GABA-A antagonist that reverses benzodiazepine effects. However, in mixed overdoses, especially with tricyclic antidepressants or in benzodiazepine-dependent patients, administering flumazenil can precipitate acute withdrawal and severe, life-threatening seizures. Respiratory arrest is the primary risk of benzodiazepine toxicity itself, not flumazenil.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.