Portal de Periódicos da CAPES

Life-Threatening Diphenhydramine Toxicity Presenting With Seizures and a Wide Complex Tachycardia Improved With Intravenous Fat Emulsion

2013; Lippincott Williams & Wilkins; Volume: 21; Issue: 6 Linguagem: Inglês

10.1097/mjt.0b013e318281191b

1536-3686

Dimyana Abdelmalek, Evan S. Schwarz, Christopher Sampson, S. Eliza Halcomb, Craig McCammon, Anna M. Arroyo-Plasencia, Adam Stenger, Nick Krehbiel, Michael E. Mullins,

Anesthesia and Pain Management

Diphenhydramine toxicity manifests with signs of anticholinergic toxicity; therapy is generally supportive. In rare cases, patients can also present with a wide complex tachycardia due to sodium channel blockade. Treatment involves sodium bicarbonate. Lidocaine and hypertonic saline are used for arrhythmias refractory to sodium bicarbonate. Although intravenous fat emulsion (IFE) therapy is proposed as an adjunctive therapy due to the lipophilicity of diphenhydramine (octanol/water partition coefficient of 3.3), successful use of IFE after a confirmed sole ingestion of diphenhydramine is not previously reported. We present the case of a 30-year-old woman presenting with seizures, a wide complex tachycardia, and cardiovascular collapse after an ingestion of diphenhydramine refractory to other therapies with rapid improvement after IFE administration.