Clinical and patient characteristics associated with severe outcome in diphenhydramine toxicity

References

• Gummin DD, Mowry JB, Spyker DA, et al. 2017 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th annual report. Clin Toxicol (Phila). 2018;56(12):1–203.
   PubMed Web of Science ®Google Scholar
• Kang AM. Substances involved in suicidal poisonings in the United States. Suicide Life Threat Behav. 2019;49(5):1307–1317.
   PubMed Web of Science ®Google Scholar
• Baker AM, Johnson DG, Levisky JA, et al. Fatal diphenhydramine intoxication in infants. J Forensic Sci. 2003;48(2):425–428.
   PubMed Web of Science ®Google Scholar
• Blackman NS, Hayes JC. Fatality associated with benadryl therapy; report of a case. J Allergy. 1948;19(6):390–392.
   PubMedGoogle Scholar
• Goetz CM, Lopez G, Dean BS, et al. Accidental childhood death from diphenhydramine overdose. Am J Emerg Med. 1990;8(4):321–322.
   PubMed Web of Science ®Google Scholar
• Hausmann E, Wewer H, Wellhoner HH, et al. Lethal intoxication with diphenhydramine. Report of a case with analytical follow-up. Arch Toxicol. 1983;53(1):33–39.
   PubMed Web of Science ®Google Scholar
• Krenzelok EP, Anderson GM, Mirick M. Massive diphenhydramine overdose resulting in death. Ann Emerg Med. 1982;11(4):212–213.
   PubMed Web of Science ®Google Scholar
• Lindsay CA, Williams GD, Levin DL. Fatal adult respiratory distress syndrome after diphenhydramine toxicity in a child: a case report. Crit Care Med. 1995;23(4):777–781.
   PubMed Web of Science ®Google Scholar
• Shkrum MJ, Hall AED, Tallon SG. Deaths due to diphenhydramine. Can Soc Forensic Sci. 1990;23(1):1–7.
   Google Scholar
• Hedegaard H, Bastian BA, Trinidad JP, et al. Drugs most frequently involved in drug overdose deaths: United States, 2011–2016. National vital statistics reports. Vol. 67. Hyattsville (MD): National Center for Health Statistics; 2018.
   Google Scholar
• Abdelmalek D, Schwarz ES, Sampson C, et al. Life-threatening diphenhydramine toxicity presenting with seizures and a wide complex tachycardia improved with intravenous fat emulsion. Am J Ther. 2014;21(6):542–544.
   PubMed Web of Science ®Google Scholar
• Abdi A, Rose E, Levine M. Diphenhydramine overdose with intraventricular conduction delay treated with hypertonic sodium bicarbonate and IV lipid emulsion. West J Emerg Med. 2014;15(7):855–858.
   PubMedGoogle Scholar
• Jang DH, Manini AF, Trueger NS, et al. Status epilepticus and wide-complex tachycardia secondary to diphenhydramine overdose. Clin Toxicol (Phila). 2010;48(9):945–948.
   PubMed Web of Science ®Google Scholar
• Johnson J, Williams K, Banner W. Adolescent with prolonged toxidrome. Clin Toxicol (Phila). 2017;55(5):364–365.
   PubMed Web of Science ®Google Scholar
• Labarinas S, Meulmester K, Greene S, et al. Extracorporeal cardiopulmonary resuscitation after diphenhydramine ingestion. J Med Toxicol. 2018;14(3):253–256.
   PubMed Web of Science ®Google Scholar
• Nine JS, Rund CR. Fatality from diphenhydramine monointoxication: a case report and review of the infant, pediatric, and adult literature. Am J Forensic Med Pathol. 2006;27(1):36–41.
   PubMed Web of Science ®Google Scholar
• Nishino T, Wakai S, Aoki H, et al. Cardiac arrest caused by diphenhydramine overdose. Acute Med Surg. 2018;5(4):380–383.
   PubMed Web of Science ®Google Scholar
• Sharma AN, Hexdall AH, Chang EK, et al. Diphenhydramine-induced wide complex tachycardia responds to treatment with sodium bicarbonate. Am J Emerg Med. 2003;21(3):212–215.
   PubMed Web of Science ®Google Scholar
• Thundiyil JG, Kearney TE, Olson KR. Evolving epidemiology of drug-induced seizures reported to a Poison Control Center System. J Med Toxicol. 2007;3(1):15–19.
   PubMedGoogle Scholar
• Palmer RB, Reynolds KM, Banner W, et al. Adverse events associated with diphenhydramine in children, 2008–2015. Clin Toxicol (Phila). 2020;58(2):99–106.
   PubMed Web of Science ®Google Scholar
• Kamei C, Ohuchi M, Sugimoto Y, et al. Mechanism responsible for epileptogenic activity by first-generation H1-antagonists in rats. Brain Res. 2000;887(1):183–186.
   PubMed Web of Science ®Google Scholar
• Isbister GK, Downes F, Sibbritt D, et al. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes. Crit Care Med. 2004;32(1):88–93.
   PubMed Web of Science ®Google Scholar
• Nedergaard M, Goldman SA, Desai S, et al. Acid-induced death in neurons and glia. J Neurosci. 1991;11(8):2489–2497.
   PubMed Web of Science ®Google Scholar
• Hoxworth JM, Xu K, Zhou Y, et al. Cerebral metabolic profile, selective neuron loss, and survival of acute and chronic hyperglycemic rats following cardiac arrest and resuscitation. Brain Res. 1999;821(2):467–479.
   PubMed Web of Science ®Google Scholar
• Koppel C, Ibe K, Tenczer J. Clinical symptomatology of diphenhydramine overdose: an evaluation of 136 cases in 1982 to 1985. J Toxicol Clin Toxicol. 1987;25(1–2):53–70.
   PubMed Web of Science ®Google Scholar
• Pragst F, Herre S, Bakdash A. Poisonings with diphenhydramine—a survey of 68 clinical and 55 death cases. Forensic Sci Int. 2006;161(2–3):189–197.
   PubMed Web of Science ®Google Scholar
• Radovanovic D, Meier PJ, Guirguis M, et al. Dose-dependent toxicity of diphenhydramine overdose. Hum Exp Toxicol. 2000;18:489–495.
   Web of Science ®Google Scholar
• Rinder CS, D'Amato S, Rinder HM, et al. Survival in complicated diphenhydramine overdose. Crit Care Med. 1988;16(11):1161–1162.
   PubMed Web of Science ®Google Scholar
• Viertal A, Sachunsky I, Wolf G, et al. Treatment of diphenhydramine intoxication with haemoperfusion. Nephrol Dial Transplant. 1994;9:1336–1338.
   PubMed Web of Science ®Google Scholar
• Adrogue HJ, Madias NE. Management of life-threatening acid–base disorders. First of two parts. N Engl J Med. 1998;338(1):26–34.
   PubMed Web of Science ®Google Scholar
• Beauchamp GA, Hendrickson RG, Hatten BW, et al. Endotracheal intubation for toxicologic exposures: a retrospective review of Toxicology Investigators Consortium (ToxIC) Cases. J Emerg Med. 2016;51(4):382–388.e11.
   PubMed Web of Science ®Google Scholar
• Beauchamp GA, Giffin SL, Horowitz BZ, et al. Poisonings associated with intubation: US National Poison Data System Exposures 2000–2013. J Med Toxicol. 2016;12(2):157–164.
   PubMed Web of Science ®Google Scholar
• Abri-Al SA, Woodburn C, Olson KR, et al. Ventricular dysrhythmias associated with poisoning and drug overdose: a 10-year review of Statewide Poison Control Center Data from California. Am J Cardiovasc Drugs. 2015;15(1):43–50.
   PubMed Web of Science ®Google Scholar
• Scharman EJ, Erdman AR, Wax PM, et al. Diphenhydramine and dimenhydrinate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(3):205–223.
   PubMed Web of Science ®Google Scholar
• Zareba W, Moss AJ, Rosero SZ, et al. Electrocardiographic findings in patients with diphenhydramine overdose. Am J Cardiol. 1997;80(9):1168–1173.
   PubMed Web of Science ®Google Scholar
• Niemann JT, Bessen HA, Rothstein RJ, et al. Electrocardiographic criteria for tricyclicantidepressant cardiotoxicity. Am J Cardiol. 1986;57(13):1154–1159.
   PubMed Web of Science ®Google Scholar
• Husain Z, Hussain K, Nair R, et al. Diphenhydramine-induced QT prolongation and torsade de pointes: an uncommon effect of a common drug. Cardiol J. 2010;17(5):509–511.
   PubMed Web of Science ®Google Scholar
• Sype JW, Khan IA. Prolonged QT interval with markedly abnormal ventricular repolarization in diphenhydramine overdose. Int J Cardiol. 2005;99(2):333–335.
   PubMed Web of Science ®Google Scholar
• Thakur AC, Aslam AK, Aslam AF, et al. QT interval prolongation in diphenhydramine toxicity. Int J Cardiol. 2005;98(2):341–343.
   PubMed Web of Science ®Google Scholar
• Manini AF, Nelson LS, Skolnick AH, et al. Electrocardiographic predictors of adverse cardiovascular events in suspected poisoning. J Med Toxicol. 2010;6(2):106–115.
   PubMedGoogle Scholar
• Manini AF, Hoffman RS, Stimmel B, et al. Clinical risk factors for in-hospital adverse cardiovascular events after acute drug overdose. Acad Emerg Med. 2015;22(5):499–507.
   PubMed Web of Science ®Google Scholar
• Adrogue HJ, Madias NE. Management of life-threatening acid–base disorders. Second of two parts. N Engl J Med. 1998;338(2):107–111.
   PubMed Web of Science ®Google Scholar
• Stucka KR, Mycyk MB, Leikin JB, et al. Rhabdomyolysis associated with unintentional overdose in a child. Pediatr Emerg Care. 2003;19:25–26.
   PubMed Web of Science ®Google Scholar
• Emadian SM, Caravati EM, Herr RD. Rhabdomyolysis: a rare adverse effect of diphenhydramine overdose. Am J Emerg Med. 1996;14(6):574–576.
   PubMed Web of Science ®Google Scholar
• Haas CE, Magram Y, Mishra A. Rhabdomyolysis and acute renal failure following an ethanol and diphenhydramine overdose. Ann Pharmacother. 2003;37(4):538–542.
   PubMed Web of Science ®Google Scholar
• Khosla U, Ruel KS, Hunt DP. Antihistamine-induced rhabdomyolysis. South Med J. 2003;96(10):1023–1026.
   PubMed Web of Science ®Google Scholar
• Frankel D, Dolgin J, Murray BM. Non-traumatic rhabdomyolysis complicating antihistamine overdose. J Toxicol Clin Toxicol. 1993;31(3):493–496.
   PubMed Web of Science ®Google Scholar
• Leybishkis B, Fasseas P, Ryan KF. Doxylamine overdose as a potential cause of rhabdomyolysis. Am J Med Sci. 2001;322(1):48–49.
   PubMed Web of Science ®Google Scholar
• Schetz M, Dasta J, Goldstein S, et al. Drug-induced acute kidney injury. Curr Opin Crit Care. 2005;11(6):555–565.
   PubMed Web of Science ®Google Scholar
• Halloran LL, Bernard DW. Management of drug-induced hyperthermia. Curr Opin Pediatr. 2004;16(2):211–215.
   PubMed Web of Science ®Google Scholar
• Chan TC, Evans SD, Clark RF. Drug-induced hyperthermia. Crit Care Clin. 1997;13(4):785–808.
   PubMed Web of Science ®Google Scholar
• Curry SC, Chang D, Connor D. Drug- and toxin-induced rhabdomyolysis. Ann Emerg Med. 1989;18(10):1068–1084.
   PubMed Web of Science ®Google Scholar
• Knochel JP, Beisel WR, Herndon EG, et al. The renal, cardiovascular, hematologic and serum electrolyte abnormalities of heat stroke. Am J Med. 1961;30:299–309.
   PubMed Web of Science ®Google Scholar