Paracetamol/diphenhydramine overdose
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Various toxicities: case report A 30-year-old woman developed lack of gag reflex, unresponsive and altered mental status following an overdose of paracetamol/diphenhydramine in an suicide attempt [duration of treatments to reactions onsets not stated]. The woman, who had a history of depression, presented to the emergency department following a suicide attempt with paracetamol/diphenhydramine [diphenhydramine and acetaminophen]. She was found unresponsive next to a bottle of paracetamol/diphenhydramine with a Glasgow coma score of 3. She had ingested paracetamol (total of 125g) and diphenhydramine [exact amount ingested not stated]. She was at baseline one hour prior to emergency department arrival. In the emergency department, she was intubated due to lack of gag reflex and altered mental status. Three hours after paracetamol/diphenhydramine ingestion, the paracetamol trough level was 826 mg/L. The woman started receiving treatment with acetylcysteine [n-acetylcysteine]. Twelve hours after ingestion, the paracetamol trough level was 331 mg/L. Twenty hours after ingestion, the paracetamol trough level was 103 mg/L, and 34 hours after ingestion it was under the instistutions detectable threshold. Her AST and ALT levels remained within normal limits throughout the hospitalisation [outcomes not stated]. Author comment: "A 30-year old female weighing 135 kg with a past medical history significant for depression presented to the emergency department (ED) as a suicide attempt with [paracetamol]. The patient was found unresponsive, next to a bottle of [paracetamol] and diphenhydramine with a Glasgow Coma Score of 3." "In the ED, the patient was intubated due to altered mental status and lack of gag reflex." Audley K, et al. Increased intravenous n-acetylcysteine dosing following massive acetaminophen ingestion. Critical Care Medicine 47 (Suppl. 1): 459 abstr. 962, No. 1, Jan 2019. Available from: URL: http:// 803432122 doi.org/10.1097/01.ccm.0000551710.54934.0a [abstract] - USA
0114-9954/19/1778-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 9 Nov 2019 No. 1778
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