Fatal diphenhydramine poisoning with increased vascular permeability including late pulmonary congestion refractory to percutaneous cardiovascular support

Figures & data

Fig 1.  Chemical structures of histamine and metabolites of diphenhydramine.

Table 1.  Fatal clinical cases of acute diphenhydramine poisoning

Age	Gender	Concentration (Time from intake)	Main symptoms	Treatments	Reference
14 yr.	F		cardiogenic shock, generalizdseizure, metabolic acidosis	partial cardiopulmonarybypass	Krenzelok et al.
15 mo.	M	10 μg/mL (3 hr)	generalized seizure, pulmonryedema	continuous thiopentalinfusion	Goetz et al.
34 mo.	F	12.8 μg/mL (1–2 hr)	generalized seizure, metabolicacidosis, cardiogenic shock, ARDS		Lindsay et al.
28 yr.	F	5 μg/mL (?)	hyperpyrexia, tachycardia,pulmonary edema		Hausmann et al.
30 yr.	F	4.7 μg/mL (?)	hypothermia, pulmonary edema	hemodialysis,hemoperfusion	Koppel et al.
39 yr.	M	0.7 μg/mL (?)	cardiogenic shock, metabolicacidosis, pulmonary edema	partial cardiopulmonarybypass	Present case

yr., years old; mo., months old; F, female; M, male; ARDS, acute respiratory distress syndrome.