Diphenhydramine Overdose with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion

Diphenhydramine Overdose with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion

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 ma...

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Main Authors: Amin Abdi, Emily Rose, Michael Levine
Format: Article
Language:English
Published: eScholarship Publishing, University of California 2014-11-01
Series:Western Journal of Emergency Medicine
Online Access:http://escholarship.org/uc/item/9rt5529p
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spelling doaj-ef154f0c469a4ceb9b01a62474efed902020-11-24T22:51:27ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182014-11-01157855858Diphenhydramine Overdose with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid EmulsionAmin Abdi0Emily Rose1Michael Levine2University of Southern California, Department of Emergency Medicine, Los Angeles, CaliforniaUniversity of Southern California, Department of Emergency Medicine, Los Angeles, CaliforniaUniversity of Southern California, Department of Emergency Medicine, Los Angeles, CaliforniaDiphenhydramine 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. [West J Emerg Med. 2014;15(7):–0.]http://escholarship.org/uc/item/9rt5529p
collection DOAJ
language English
format Article
sources DOAJ
author Amin Abdi
Emily Rose
Michael Levine
spellingShingle Amin Abdi
Emily Rose
Michael Levine
Diphenhydramine Overdose with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion
Western Journal of Emergency Medicine
author_facet Amin Abdi
Emily Rose
Michael Levine
author_sort Amin Abdi
title Diphenhydramine Overdose with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion
title_short Diphenhydramine Overdose with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion
title_full Diphenhydramine Overdose with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion
title_fullStr Diphenhydramine Overdose with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion
title_full_unstemmed Diphenhydramine Overdose with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion
title_sort diphenhydramine overdose with intraventricular conduction delay treated with hypertonic sodium bicarbonate and iv lipid emulsion
publisher eScholarship Publishing, University of California
series Western Journal of Emergency Medicine
issn 1936-900X
1936-9018
publishDate 2014-11-01
description 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. [West J Emerg Med. 2014;15(7):–0.]
url http://escholarship.org/uc/item/9rt5529p
work_keys_str_mv AT aminabdi diphenhydramineoverdosewithintraventricularconductiondelaytreatedwithhypertonicsodiumbicarbonateandivlipidemulsion
AT emilyrose diphenhydramineoverdosewithintraventricularconductiondelaytreatedwithhypertonicsodiumbicarbonateandivlipidemulsion
AT michaellevine diphenhydramineoverdosewithintraventricularconductiondelaytreatedwithhypertonicsodiumbicarbonateandivlipidemulsion
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