Flumazenil for Hypoactive Delirium Secondary to Benzodiazepine Exposure

Exclusion Criteria

• •1. contraindications to flumazenil including hypersensitivity
• •2. receipt of benzodiazepines for control of potentially life-threatening conditions (e.g., control of intracranial pressure or status epilepticus)
• •3. active seizure disorder or on current anti-convulsant therapy for history of seizure disorder. Seizures secondary to alcohol withdrawal will NOT be excluded.
• •4. history of traumatic brain injury complicated by seizures
• •5. acute episode (within prior 30 days) of severe traumatic brain injury
• •6. history of structural lesion (e.g. subarachnoid hemorrhage, cerebrovascular accident, intra-parenchymal hemorrhage) complicated by seizures
• •7. acute episode (within prior 14 days) of structural lesion (e.g. subarachnoid hemorrhage, cerebrovascular accident, intra-parenchymal hemorrhage)
• •8. brain tumor complicated by seizure
• •9. history of anoxic brain injury
• •10. third-degree burn with total body surface area (TBSA) burn greater than 20%
• •11. chronic benzodiazepine (clonazepam:lorazepam:diazepam approximately 4:8:40 mg per day) for 7 consecutive days with no taper
• •12. chronic delirium that is attributable to other causes
• •13. anticipated to transfer to lower level of care within 24 hours
• •14. admitted for polysubstance overdose as determined by initial drug toxicity screening
• •15. recent exposure (prior 7 days) to pro-convulsant medications (identified via medication list, medication reconciliation performed by PI/pharmacy medication reconciliation team, or urine drug screening)
• •16. children, incarcerated individuals, and pregnant women
• •17. unable to provide consent and the legally authorized representative is unable to provide consent