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Drug toxicity following overdose leading to various toxicities: case report A 13-year-old girl developed hypertension, tachycardia, confusion, tremulous, hallucination, seizures, hypokalaemia and hyperchloraemia following drug toxicity and overdose of diphenhydramine. Additionally, the treatment with lorazepam for seizures led to its toxicity [routes and dosages not stated]. The girl, had a history of depression and was on daily administration of fluoxetine. She presented to the emergency department with hypertension, tachycardia, confused, tremulous and hallucination. She also had recurrent seizures and was successful treated with unspecified isotonic fluids and multiple doses of lorazepam. An ECG demonstrated tachycardia with heart rate 124 bpm, QTc of 443ms and QRS of 86ms. She additionally had mild hypokalaemia and hyperchloraemia. The qualitative urine immunoassay revealed drug abuse positive for opiates, tetrahydrocannabinol (THC) and benzodiazepines. She completely improved following 24 hours. Subsequently, she reported vaping of all contents of an e-cigarette cartridge [contents not specified] before onset of the symptoms. She denied any other exposure or ingestions. Her initial symptoms were thought to be associated with nicotine toxicity, however, antimuscarinic and sympathomimetic toxicity were also consider. To exclude other possible causes urine gas chromatography/mass spectrophotometry revealed toxicological significance of delta-9 carboxy THC, lorazepam >500 ng/mL and diphenhydramine 1100 ng/mL. Nicotine and cotinine were not revealed in the sample. The concentration of diphenhydramine was consistent with toxicity and severe overdose and toxicological significance of lorazepam indicated its toxicity. Hughes A, et al. Does vaping cause seizures? The need for comprehensive drug testing. Clinical Toxicology 58: 217-218, No. 3, Mar 2020. Available from: URL: http:// 803499473 doi.org/10.1080/15563650.2019.1618468

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Reactions 5 Sep 2020 No. 1820