Presenter Status
Fellow
Abstract Type
Case report
Primary Mentor
Dr. Stephen Pfeiffer
Start Date
11-5-2023 11:30 AM
End Date
11-5-2023 1:30 PM
Presentation Type
Poster Presentation
Description
Background: The Covid-19 pandemic has adversely affected the mental health of children causing an increased incidence of suicide attempts. Diphenhydramine is a common household medication and is frequently ingested by children. Toxic doses of diphenhydramine can affect the cardiovascular and central nervous system. In the heart, diphenhydramine blocks fast sodium channels and potassium channels which can result in conduction abnormalities including sinus tachycardia, widening of QRS duration, ventricular tachycardia and torsades de pointes. Massive ingestion can cause severe cardiovascular collapse which may require ECMO support
Objectives/Goal: To describe a novel method of clearing highly protein-bound diphenhydramine molecules from circulation after a massive intentional ingestion
Methods/Design: We performed 1.7 plasma volume therapeutic plasma exchange (TPE) by using 5% albumin and fresh frozen plasma as replacement fluid to treat refractory ventricular arrhythmia in a hemodynamically unstable patient with diphenhydramine toxicity
Results: Following TPE, the serum level of diphenhydramine decreased from 1300 ng/ml to 770 ng/ml. The patient showed signs of clinical improvement with did not have any further arrhythmias
Conclusions: TPE is traditionally not performed for diphenhydramine toxicity as the data regarding its utility is limited. The decrease in drug levels before and after TPE treatment was associated with improvement in the patient’s hemodynamics and rhythm. This case report is unique because, to the best of our knowledge, the use of TPE in diphenhydramine toxicity has not been reported in medical literature. TPE may be considered as a treatment option in hospitals that do not have ECMO support or as an alternative therapeutic modality for patients with diphenhydramine toxicity
MeSH Keywords
diphenhydramine hydrochloride; overdose; plasma exchange
Included in
Cardiology Commons, Critical Care Commons, Higher Education and Teaching Commons, Medical Education Commons, Medical Toxicology Commons, Pediatrics Commons
Therapeutic Plasma Exchange to Alleviate Ventricular Tachycardia After Diphenhydramine Ingestion
Background: The Covid-19 pandemic has adversely affected the mental health of children causing an increased incidence of suicide attempts. Diphenhydramine is a common household medication and is frequently ingested by children. Toxic doses of diphenhydramine can affect the cardiovascular and central nervous system. In the heart, diphenhydramine blocks fast sodium channels and potassium channels which can result in conduction abnormalities including sinus tachycardia, widening of QRS duration, ventricular tachycardia and torsades de pointes. Massive ingestion can cause severe cardiovascular collapse which may require ECMO support
Objectives/Goal: To describe a novel method of clearing highly protein-bound diphenhydramine molecules from circulation after a massive intentional ingestion
Methods/Design: We performed 1.7 plasma volume therapeutic plasma exchange (TPE) by using 5% albumin and fresh frozen plasma as replacement fluid to treat refractory ventricular arrhythmia in a hemodynamically unstable patient with diphenhydramine toxicity
Results: Following TPE, the serum level of diphenhydramine decreased from 1300 ng/ml to 770 ng/ml. The patient showed signs of clinical improvement with did not have any further arrhythmias
Conclusions: TPE is traditionally not performed for diphenhydramine toxicity as the data regarding its utility is limited. The decrease in drug levels before and after TPE treatment was associated with improvement in the patient’s hemodynamics and rhythm. This case report is unique because, to the best of our knowledge, the use of TPE in diphenhydramine toxicity has not been reported in medical literature. TPE may be considered as a treatment option in hospitals that do not have ECMO support or as an alternative therapeutic modality for patients with diphenhydramine toxicity
