Sun21November1151AM 9

A 7-year-old girl presents to the Emergency Department with a history of seizure that has resolved with rectal diazepam administered by the mother 20 minutes ago. She is a known epileptic.

On examination, the patient is unconscious but has normal spontaneous breathing in room air. Blood pressure 100/70 mmHg, capillary refill time 1.5 seconds, and temperature 37.7°C. On further questioning, you discover that the mother has given three times the recommended dose of buccal midazolam.

What is the next step in the management plan?

(Please select 1 option)

IV Ceftriaxone

Place an NGT and give activated charcoal

Close observation Correct

Urgent flumazenil IV

Elective ET intubation

Explanation

Benzodiazepine overdose is rarely seen in paediatric age group, but epileptic children are more prone to overdoses due to human error by parents. There is no need to treat benzodiazepine overdose unless it causes a severe respiratory depression. So, as this patient is breathing spontaneously with stable vital signs, close observation and supportive care are all that is needed.

Elective intubation is not indicated at this stage and should not be considered.

Most patients who present with seizures are expected to have a mild degree of fever. So, giving antibiotics at this stage is not recommended unless there are other signs of infection.

Activated charcoal can be used in case of oral diazepam overdose which is not usually seen in young children.

Flumazenil is not indicated as the patient is not having respiratory depression. Her comatose state is simply a postictal state, which is expected. In addition, if Flumazenil is given it may reverse the therapeutic action of diazepam and the child may then develop a seizure again.

Reference:

Patient.info. Benzodiazepine Dependence.

Answer Statistics

1

2%

2

1%

3

87%

4

2%

5

11%

Times answered: 266