Life-threatening diphenhydramine toxicity presenting with seizures and a wide complex tachycardia improved with intravenous fat emulsion.
| Title: | Life-threatening diphenhydramine toxicity presenting with seizures and a wide complex tachycardia improved with intravenous fat emulsion. |
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| Authors: | Abdelmalek D; 1Barnes-Jewish Hospital, Division of Emergency Medicine, St Louis, MO; 2Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO; and Barnes-Jewish Hospital, Department of Pharmacy, St Louis, MO.; Schwarz ES; Sampson C; Halcomb SE; McCammon C; Arroyo-Plasencia A; Stenger A; Krehbiel N; Mullins ME |
| Source: | American journal of therapeutics [Am J Ther] 2014 Nov-Dec; Vol. 21 (6), pp. 542-4. |
| Publication Type: | Case Reports; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 9441347 Publication Model: Print Cited Medium: Internet ISSN: 1536-3686 (Electronic) Linking ISSN: 10752765 NLM ISO Abbreviation: Am J Ther Subsets: MEDLINE |
| Imprint Name(s): | Publication: 1998- : Philadelphia, PA : Lippincott Williams & Wilkins; Original Publication: New York, NY : Chapman & Hall, c1994- |
| MeSH Terms: | Diphenhydramine/*poisoning ; Fat Emulsions, Intravenous/*therapeutic use ; Seizures/*chemically induced ; Tachycardia/*chemically induced; Seizures/therapy ; Tachycardia/therapy ; Adult ; Drug Overdose ; Female ; Humans |
| Abstract: | Diphenhydramine toxicity manifests with signs of anticholinergic toxicity; therapy is generally supportive. In rare cases, patients can also present with a wide complex tachycardia due to sodium channel blockade. Treatment involves sodium bicarbonate. Lidocaine and hypertonic saline are used for arrhythmias refractory to sodium bicarbonate. Although intravenous fat emulsion (IFE) therapy is proposed as an adjunctive therapy due to the lipophilicity of diphenhydramine (octanol/water partition coefficient of 3.3), successful use of IFE after a confirmed sole ingestion of diphenhydramine is not previously reported. We present the case of a 30-year-old woman presenting with seizures, a wide complex tachycardia, and cardiovascular collapse after an ingestion of diphenhydramine refractory to other therapies with rapid improvement after IFE administration. |
| Substance Nomenclature: | 0 (Fat Emulsions, Intravenous); 8GTS82S83M (Diphenhydramine) |
| Entry Date(s): | Date Created: 20131008 Date Completed: 20150706 Latest Revision: 20141106 |
| Update Code: | 20260130 |
| DOI: | 10.1097/MJT.0b013e318281191b |
| PMID: | 24096706 |
| Database: | MEDLINE |
Case Reports; Journal Article