title: Dose-dependent toxicity of diphenhydramine overdose.
abstract: BACKGROUND
  Diphenhydramine (DPHM) overdose is a frequent cause of acute poisoning. Although its clinical features are well known, information about the dose-dependent toxicity of DPHM is still scarce. The objective of this study was to investigate the dose-dependent toxicity of DPHM in patients with acute DPHM poisoning.
  
  
  METHODS
  We have analyzed retrospectively all well-documented cases with DPHM monointoxications reported by physicians to the Swiss Toxicological Information Centre (STIC) between January 1984 and April 1996. In addition, a prospective study focusing on ingested DPHM doses and severity of symptoms was performed between May 1996 and December 1998.
  
  
  RESULTS
  The retrospective and prospective studies included 232 and 50 patients with DPHM monointoxications, respectively. In both studies, mild symptoms (somnolence, anticholinergic signs, tachycardia, nausea/vomiting) occurred in 55-64%, moderate symptoms (isolated and spontaneously resolving agitation, confusion, hallucinations and ECG disturbances) in 22-27% and severe symptoms (delirium/psychosis, seizures, coma) in 14-18% of patients. Moderate symptoms occurred above ingested doses of 0.3 g DPHM. For severe symptoms the critical dose limit was 1.0 g DPHM. Although the frequency of delirium/psychosis remained constant or even decreased, coma and seizures were significantly (p<0.05) more frequent in the >1.5-g compared with the 1.0- to 1.5-g-dose group.
  
  
  CONCLUSIONS
  These data demonstrate a clear dose-dependent acute toxicity of DPHM. They indicate that only patients with DPHM ingestions above 1.0 g are at risk for the development of severe symptoms and, therefore, should be hospitalized. Thus, the results contribute to the data basis required for a cost effective management of patients with DPHM overdose.
authors.affiliation: Swiss Toxicological Information Centre, Zurich.
authors.forename: D
authors.initials: D
authors.lastname: Radovanovic
authors.forename: P J
authors.initials: PJ
authors.lastname: Meier
authors.forename: M
authors.initials: M
authors.lastname: Guirguis
authors.forename: J P
authors.initials: JP
authors.lastname: Lorent
authors.forename: H
authors.initials: H
authors.lastname: Kupferschmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004155:Diphenhydramine / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D006634:Histamine H1 Antagonists; D004155:Diphenhydramine