title: Diphenhydramine overdose with intraventricular conduction delay treated with hypertonic sodium bicarbonate and i.v. lipid emulsion.
abstract: Diphenhydramine toxicity commonly manifests with antimuscarinic features, including dry mucous membranes, tachycardia, urinary retention, mydriasis, tachycardia, and encephalopathy. Severe toxicity can include seizures and intraventricular conduction delay. We present here a case of a 23-year-old male presenting with recurrent seizures, hypotension and wide complex tachycardia who had worsening toxicity despite treatment with sodium bicarbonate. The patient was ultimately treated with intravenous lipid emulsion therapy that was temporally associated with improvement in the QRS duration. We also review the current literature that supports lipid use in refractory diphenhydramine toxicity.
authors.affiliation: University of Southern California, Department of Emergency Medicine, Los Angeles, California.
authors.forename: Amin
authors.initials: A
authors.lastname: Abdi
authors.affiliation: University of Southern California, Department of Emergency Medicine, Los Angeles, California ; University of Southern California, Department of Pediatrics, Los Angeles, California.
authors.forename: Emily
authors.initials: E
authors.lastname: Rose
authors.affiliation: University of Southern California, Department of Emergency Medicine, Los Angeles, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Levine
mesh_terms: D000931:Antidotes / Q000627:therapeutic use*; D004155:Diphenhydramine / Q000506:poisoning*; D062787:Drug Overdose / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D006634:Histamine H1 Antagonists / Q000506:poisoning*; D006801:Humans; D006982:Hypertonic Solutions; D008297:Male; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000931:Antidotes; D005217:Fat Emulsions, Intravenous; D006634:Histamine H1 Antagonists; D006982:Hypertonic Solutions; D004155:Diphenhydramine; D017693:Sodium Bicarbonate