Use of a flumazenil infusion to treat chlordiazepoxide toxicity

“Alcohol detox” is a common presentation to acute medical services and is usually managed via standardised guidelines and protocols. We present a case of chlordiazepoxide toxicity, requiring repeated bolus doses and subsequently 24 hours of an intravenous infusion of flumazenil in response to guideline directed management of an alcohol withdrawal state. The use of prolonged flumazenil infusions to treat benzodiazepine toxicity is infrequently described. Chlordiazepoxide is metabolised in the hepatic microsomal pathway and hepatic impairment can lead to accumulation of toxic metabolites, which may have been the explanation for toxicity in this case. In patients at risk of liver dysfunction we advise the use of benzodiazepines not requiring phase 1 oxidative metabolism, such as lorazepam or oxazepam.</jats:p

An unusual Cause of Periorbital Swelling in a Young Female

A 16 year old female was admitted with a one week history of headache and swelling of both upper eyelids. Other symptoms included nausea, tiredness, dizziness and photophobia with no symptoms of skin rash, or neck stiffness. She had been previously very well with no significant past medical history.</jats:p