Reversal of ethanol-induced respiratory depression by flumazenil

Flumazenil is effective in reversing sedation resulting from benzodiazepine (BZD) toxicity. Its use for other causes of sedation have not been well described. A 23-y-old male was found unconscious. Upon being aroused, the patient stated he had recently ingested 1 1/2 bottles of vodka/beer and 250 mg of diazepam. Physical examination revealed shallow breathing and respiratory depression. Arterial blood gases were consistent with the clinical diagnosis of respiratory depression (pH 7.34, pCO2 47, pO2 99). However, after receiving 3 mg of flumazenil, the respiratory depression improved so that the patient no longer required intubation. The drug screen returned negative for BZDs and the patient had a blood alcohol level of 332 mg/dl. He later denied BZD use. The patient's clinical course improved throughout the study period, and mechanical ventilation was avoided. This report reflects a possible role for flumazenil in reversing the respiratory depression produced by ethanol ingestion.