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
WARNINGS Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take acetaminophen or other pain relievers/fever reducers. Acetaminophen may cause liver damage. PRECAUTIONS No information provided. [rxlist.com]
ULTRATABS<sup>®</sup> Tablets with Allergy Relief and Diphenhydramine HCI 25mg Where to Buy Product Description Use BENADRYL® Allergy ULTRATABS® Tablets with 25 mg of diphenhydramine HCI, antihistamine, for effective relief from symptoms related to hay fever [benadryl.com]
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]
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]
- 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]
If you've taken more than the usual dose you may: feel very sleepy feel sick (nauseous) get blurry eyesight feel your heart beating very fast In serious cases you can become unconscious and may need emergency treatment in hospital. [nhs.uk]
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]
Cardiovascular
- Tachycardia
Diphenhydramine toxicity commonly manifests with antimuscarinic features, including dry mucous membranes, tachycardia, urinary retention, mydriasis, tachycardia, and encephalopathy. [ncbi.nlm.nih.gov]
RF and Vance MV, Massive Diphenhydramine Poisoning Resulting in a Wide-Complex Tachycardia: Successful Treatment with Sodium bicarbonate [Annul Emergency Medicine 1992;21;318-321] [en.wikibooks.org]
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]
Incidence not known hypotension / Rapid / Incidence not known palpitations / Early / Incidence not known Mild drowsiness / Early / 22.1-22.1 restlessness / Early / 1.0-10.0 asthenia / Delayed / 4.4-4.4 headache / Early / 2.5-2.5 dizziness / Early / 2.5-2.5 xerostomia [pdr.net]
Neurologic
- Confusion
[…] 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]
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]
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]
Treatment
Consider treatment alternatives when possible. Loratadine may be considered as an alternative for the treatment of allergy symptoms. [pdr.net]
After treatment with sodium bicarbonate failed to improve cardiac status, the patient underwent emergency charcoal hemoperfusion and hemodialysis with rapid improvement in the ECG findings within the first 40 minutes of treatment and with no further need [ncbi.nlm.nih.gov]
[…] diphenhydramine [ di″fen-hi´drah-mēn ] an antihistamine with anticholinergic effects; the hydrochloride salt is used for relief of allergic symptoms, for treatment of anaphylaxis, parkinsonism, and motion sickness or other causes of nausea, vomiting, [medical-dictionary.thefreedictionary.com]
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]
Fluids through a vein (by IV) Medicines to treat symptoms or reverse the effects of the overdose Activated charcoal Laxative Breathing support, including a tube through the mouth into the lungs and connected to a breathing machine (ventilator) Outlook (Prognosis [mountsinai.org]
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. [web.archive.org]
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]
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. [web.archive.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]
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]
This prevents histamine-induced bronchoconstriction, vasodilation, increased capillary permeability, and GI smooth muscle spasms. [fpnotebook.com]