Citation

Carlsson J, Götz J, Meierhenrich R, Miketic S, Sorges E, Tebbe U. Intensivmedizin und Notfallmedizin 1996; 33(5): 327-333.

Copyright

(Copyright © 1996)

DOI

unavailable

PMID

unavailable

Abstract

The data of 515 patients, treated between January 1, 1990 and December 31, 1993 in the intensive care unit because of acute poisoning, were analyzed retrospectively (8% of total patient number). 36 of these patients (7% of all intoxications) had taken the over-the-counter H1-antihistaminic drugs doxylamine (n = 15) and diphenhydramine (n = 21), all with suicidal intent. The patients were 29.3 ± 8.7 years old, 24 were female, 12 male. The ingested dose ranged between the 10 and 200 fold of a therapeutic dose. The patients most frequently presented with anticholinergic symptoms. Prevention of poison absorption was attempted (3.7 ± 2.6 after ingestion) with gastric lavage and administration of activated charcoal and sodium sulfate. Twelve patients (33%; 7 doxylamine- and 5 diphenhydramine-intoxications) developed rhabdomyolysis with a maximum CPK elevation of 6739 ± 6998 U/L (1409-21400). With alkaline diuresis only one of these patients developed transient impairment of renal function. Patients with rhabdomyolysis had taken higher amounts of antihistamines (1606 ± 1291 versus 750 ± 631 mg) and presented later to the hospital after intoxication (4.6 ± 3.3 versus 3.4 ± 2.2 h) compared with patients who did not develop rhabdomyolysis. Rhabdomyolysis is a common complication of intoxication with doxylamine and diphenhydramine. Even in patients without any initial symptoms careful monitoring in the hospital with check of CPK and creatine is warranted since increase of CPK in some cases develops up to 36 h after the intoxication.

Language: de

Keywords

adult; human; suicide; female; male; rhabdomyolysis; intoxication; article; major clinical study; doxylamine; stomach lavage; activated carbon; diphenhydramine; antihistaminic agent; non prescription drug; creatine kinase; sodium sulfate; antihistamines