Toxicology: flumazenil in mixed overdose: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Toxicology: flumazenil in mixed overdose

Sample item

A 30-year-old woman is found drowsy with empty strips of amitriptyline and clonazepam. Her respiratory rate is low and her ECG shows a QRS of 130 ms. A junior suggests giving flumazenil. Why should it be avoided?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Reversal of the benzodiazepine can unmask tricyclic seizures and arrhythmias

Benzodiazepines suppress the convulsant effect of tricyclic antidepressants. Giving flumazenil removes this protection and can precipitate seizures and arrhythmias, particularly with a widened QRS. Airway support, bicarbonate for QRS widening and benzodiazepines for seizures are preferred.

Option by option

  • A. Flumazenil causes severe hypoglycaemia

    Hypoglycaemia is not an effect of flumazenil.

  • B. Flumazenil precipitates methaemoglobinaemia

    Methaemoglobinaemia is not an effect of flumazenil.

  • C. Flumazenil has no action at benzodiazepine receptors

    Flumazenil does antagonise the benzodiazepine receptor, which is the problem here.

  • D. Reversal of the benzodiazepine can unmask tricyclic seizures and arrhythmias (correct)

    Correct. Flumazenil can precipitate seizures in tricyclic co-ingestion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is D, Reversal of the benzodiazepine can unmask tricyclic seizures and arrhythmias. Benzodiazepines suppress the convulsant effect of tricyclic antidepressants.

Why is "Flumazenil causes severe hypoglycaemia" not the answer?

Hypoglycaemia is not an effect of flumazenil.

Why is "Flumazenil precipitates methaemoglobinaemia" not the answer?

Methaemoglobinaemia is not an effect of flumazenil.

Why is "Flumazenil has no action at benzodiazepine receptors" not the answer?

Flumazenil does antagonise the benzodiazepine receptor, which is the problem here.

What concept does this question test?

It tests Toxicology: flumazenil in mixed overdose in Forensic Medicine. Giving flumazenil removes this protection and can precipitate seizures and arrhythmias, particularly with a widened QRS. Airway support, bicarbonate for QRS widening and benzodiazepines for seizures are preferred.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Toxicology: flumazenil in mixed overdose?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.