TY - JOUR
T1 - Life-threatening diphenhydramine toxicity presenting with seizures and a Wide complex tachycardia improved with intravenous fat emulsion
AU - Abdelmalek, Dimyana
AU - Schwarz, Evan S.
AU - Sampson, Christopher
AU - Halcomb, Sarah E.
AU - McCammon, Craig
AU - Arroyo-Plasencia, Anna
AU - Stenger, Adam
AU - Krehbiel, Nick
AU - Mullins, Michael E.
N1 - Publisher Copyright:
© 2013 Lippincott Williams & Wilkins.
PY - 2014/12/4
Y1 - 2014/12/4
N2 - 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.
AB - 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.
KW - Anticholinergic overdose
KW - Diphenhydramine toxicity
KW - Intravenous fat emulsion
KW - Seizure
KW - Wide complex tachycardia
UR - http://www.scopus.com/inward/record.url?scp=84914167882&partnerID=8YFLogxK
U2 - 10.1097/MJT.0b013e318281191b
DO - 10.1097/MJT.0b013e318281191b
M3 - Article
C2 - 24096706
AN - SCOPUS:84914167882
SN - 1075-2765
VL - 21
SP - 542
EP - 544
JO - American Journal of Therapeutics
JF - American Journal of Therapeutics
IS - 6
ER -