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

Additional Files

1376_Kaushal Dosani-Abstract.pdf (207 kB)
Abstract

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May 11th, 11:30 AM May 11th, 1:30 PM

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