Presentation
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. [ncbi.nlm.nih.gov]
Entire Body System
-
Fever
Phenylephrine: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; chest pain; decreased coordination; difficulty urinating; fast or irregular heartbeat; fever [web.archive.org]
INDICATIONS Benadryl Allergy (diphenhydramine) Uses temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: runny nose sneezing itchy, watery eyes itching of the nose or throat temporarily relieves these symptoms due [rxlist.com]
Bottles Get relief from hay fever and seasonal allergies! Mini tablets are easy to swallow, yet pack a punch against allergies with 25 mg of the antihistamine Diphenhydramine Hydrochloride. [dollartree.com]
[…] pronounced as (dye fen hye' dra meen) Diphenhydramine is used to relieve red, irritated, itchy, watery eyes; sneezing; and runny nose caused by hay fever, allergies, or the common cold. [medlineplus.gov]
-
Intravenous Administration
A rare occurrence of DPH abuse via documented intravenous administration leading to death is presented. [ncbi.nlm.nih.gov]
After intravenous administration of 0.8 mg/kg diphenhydramine, a prolonged half-life was noted in patients with chronic liver disease which correlated with the severity of the disease 16. [drugbank.ca]
-
Unconsciousness
He was found unconscious and hypotensive. His serum potassium concentration was 8.3 mEq/L and the ECG revealed a coved-type ST-segment elevation in leads V2-V3. [ncbi.nlm.nih.gov]
Use gastric lavage if patient is unconscious or ipecac fails. Treat hypotension with vasopressors and control seizures with diazepam or phenytoin. Don’t give stimulants. [glowm.com]
Hypotension, manifest as dizziness, shock and unconsciousness or both, occurs in only 10 to 30% of individuals with anaphylaxis ( Brown 2001 ; Brown 2004a ; Kemp 2002 ; Lieberman 2003 ; Simons 2002 ). [doi.org]
-
Increased Energy
energy, restlessness, nervousness, euphoria, anxiety, hallucinations, insomnia, irritability [ Ref ] Cardiovascular Rare (0.01% to 0.1%): Palpitations, hypotension, arrhythmia Frequency not reported : Tachycardia, chest tightness, extrasystoles [ Ref [drugs.com]
Gastrointestinal
-
Morning Sickness
sickness remedies) D00669 Diphenhydramine hydrochloride (JP17/USP) Allergic agents 52 Antihistamine based drugs D00669 Diphenhydramine hydrochloride (JP17/USP) Agents for integumentary system 57 Analgesic, antipruritic, astringent, and anti-inflammatory [kegg.jp]
Jaw & Teeth
-
Xerostomia
While xerostomia can be a mild aggravation for the patient and may not appear to be clinically relevant, chronic xerostomia can increase the risk for dental caries as well as worsen symptoms of gastroesophageal reflux disease (GERD). [ebmconsult.com]
Interactions Found Interactions Found Serious - Use Alternative Significant - Monitor Closely All Interactions Sort By: Adverse Effects Frequency Not Defined Sedation Confusion Anticholinergic effects May decrease cognitive function in geriatric patients Xerostomia [reference.medscape.com]
Cardiovascular
-
Tachycardia
Diphenhydramine toxicity commonly manifests with antimuscarinic features, including dry mucous membranes, tachycardia, urinary retention, mydriasis, tachycardia, and encephalopathy. [ncbi.nlm.nih.gov]
Musculoskeletal
-
Swelling of Hand
[…] of hands, legs, or feet; tremor; unusual bruising or bleeding; unusual joint or muscle pain; unusual tiredness or weakness; vision or speech changes; vomit that looks like coffee grounds; wheezing; yellowing of the skin or eyes. [web.archive.org]
Urogenital
-
Regular Uterine Contractions
One case report of a pregnant woman who ingested a large amount of diphenhydramine in an attempted suicide developed strong, regular uterine contractions that were halted by the administration of intravenous magnesium. [web.archive.org]
Neurologic
-
Confusion
Diphenhydramine/Ibuprofen: Severe allergic reactions (rash; hives; itching; trouble breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody or black, tarry stools; change in the amount of urine produced; chest pain; confusion [web.archive.org]
[…] infants, diphenhydramine in over-dosage may cause convulsions or death May cause significant sedation or paradoxical excitation/akethesia Diphenhydramine has additive effects with alcohol and other CNS depressants Antihistamines may cause dizziness, confusion [orangecountyfl.net]
Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness, confusion, constipation, or trouble urinating. Drowsiness, dizziness, and confusion can increase the risk of falling. [webmd.com]
] Other Common (1% to 10%): Fatigue Frequency not reported : Lassitude, tinnitus, acute labyrinthitis, asthenia, chills, impaired performance (including impaired driving, work, and/or information processing) [ Ref ] Psychiatric Rare (0.01% to 0.1%): Confusion [drugs.com]
-
Seizure
The generalized seizures continued for duration of 30 min, despite the intravenous administration of 8 mg of lorazepam. The patient underwent endotracheal intubation and a propofol infusion terminated her seizures. [ncbi.nlm.nih.gov]
[…] reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; chest pain; decreased coordination; difficulty urinating; fast or irregular heartbeat; fever; hallucinations; seizure [web.archive.org]
Midazolam was administered with seizure resolution. Examination revealed 4-mm reactive pupils; nystagmus; warm, dry, flushed skin; and altered mental status. [doi.org]
Workup
Further workup revealed urinary diphenhydramine levels suggesting drug overdose. This case serves as a reminder of the oxytocin-like effects of diphenhydramine. [ncbi.nlm.nih.gov]
[…] depression Head CT scan, in patients with seizures or altered mental status ECG, especially if tachycardia or bradycardia is present Lumbar puncture, if patient has altered mental status or new-onset seizures in the setting of an unknown toxic exposure See Workup [emedicine.medscape.com]
Treatment
No child required critical treatments. Our agreement on chart review for 20% of the cases was very good for "serious clinical effects" (kappa, 0.79; 95% CI, 0.39-1.0) and excellent for "critical treatments" (kappa, 1.0). [ncbi.nlm.nih.gov]
[The treatment of dry cough in orhinolaryngology] [In German] ZFA (Stuttgart). 1976;52(10):542–3. Google Scholar 29. Weilacher JS [Cough and its treatment with a new cough-blocking drug] [In German]. Z Allgemeinmed. 1972;48(4):185–7. [doi.org]
Prognosis
The patient may receive: Activated charcoal Breathing support Fluids through a vein (by IV) Tube through the mouth into the stomach to wash out the stomach ( gastric lavage ) Outlook (Prognosis) Recovery is likely if the patient survives the first 24 [web.archive.org]
Prognosis The prognosis is affected by the presence of underlying medical conditions, co-ingestions, and the amount of drug ingested. The vast majority of patients recover with supportive care and observation. [emedicine.medscape.com]
Etiology
Fetal tachycardia is attributable to a variety of etiologies, including an untreated maternal medical condition or an indicator of potential fetal compromise. Maternal medication administration may also affect the fetal heart rate. [ncbi.nlm.nih.gov]
View/Print Figure Etiology of Nausea and Vomiting FIGURE 1. Physiologic mechanisms that result in nausea and vomiting. Etiology of Nausea and Vomiting FIGURE 1. Physiologic mechanisms that result in nausea and vomiting. [aafp.org]
Etiology The 3 main components of most cough and cold medicines, and the source of toxicity from them, are antihistamines, decongestants, and antitussives. Allergy medications typically contain antihistamines, decongestants, or both. [emedicine.medscape.com]
Epidemiology
On the other hand, alcohol provokes food-induced histaminosis and histamine intolerance, which is an epidemiological problem. [doi.org]
Epidemiology of cough. Pulm Pharmacol Ther. 2002 ; 15 : 253 – 259 Gruber CM, Carter CH. A measure of the effectiveness of propoxyphene antitussives in children. Am J Med Sci. 1961 ; 242 : 443 – 446 Carter CH. [pediatrics.aappublications.org]
Furthermore, no study has shown a benefit in the management of these conditions with either antihistamines or decongestants. [53] Epidemiology The AAPCC reported that in the United States in 2014, cough and cold preparations accounted for 60,300 total [emedicine.medscape.com]
Pathophysiology
Patient Information Handout An understanding of the pathophysiology of nausea and the mechanisms of antiemetics can help family physicians improve the cost-effectiveness and efficacy of therapy. [aafp.org]
This mechanistic distinction is seldom used now, as it is recognized that the clinical picture and the treatment of anaphylaxis are similar regardless of trigger factor or pathophysiologic mechanisms ( Kemp 2002 ; Lieberman 2003 ). [doi.org]
Pathophysiology The principal active ingredients in cough and cold medications are antihistamines, decongestants, and antitussives. Allergy medications typically contain antihistamines, decongestants, or both. [emedicine.medscape.com]
Prevention
PURPOSE: In this study the potential of diphenhydramine in reducing respectively preventing vertigo and nausea induced by the ultra-high static magnetic field at 7 T was evaluated. [ncbi.nlm.nih.gov]
Pharmacologic properties: Diphenhydramine is a histamine H1-receptor antagonist that prevents the release of histamine from effector mast cells. [orangecountyfl.net]
[…] allergic symptoms, even though they don’t prevent its release. [glowm.com]