A Case Report of Continuous Flumazenil Infusion in a Nonagenarian With Benzodiazepine Toxicity, Managed Outside...

Benzodiazepine overdose in older adults with renal impairment can lead to prolonged coma and respiratory depression. Flumazenil is an available antidote, though its use in continuous infusion is rarely documented, especially in geriatric patients outside intensive care. We report the case of a 93-year-old man with chronic kidney disease and acquired solitary kidney who was admitted for acute respiratory failure secondary to aspiration pneumonia. During hospitalization, the patient developed a profound and persistent alteration of consciousness with stertorous breathing and hypotension. After a positive response to a test dose of flumazenil, a continuous infusion was started, resulting in full neurological recovery. The infusion was tapered over 72 hours without significant adverse effects. Unfortunately, the patient died as a result of sepsis caused by Enterococcus faecalis. Continuous flumazenil infusion may be a valuable therapeutic strategy in selected elderly patients with suspected benzodiazepine intoxication, allowing resolution of sedation while managing concurrent acute illnesses.