Diphenhydramine-induced wide complex dysrhythmia responds to treatment with sodium bicarbonate

Sharma, Adhi N.; Hexdall, Aaron; Chang, Elbert; Nelson, Lewis S.; Hoffman, Robert S.

doi:10.1016/s0735-6757(02)42248-6

Cited by 51 publications

(32 citation statements)

References 11 publications

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“…In a small percentage of patients, diphenhydramine and other first-generation antihistamines have also been associated with cardiotoxicity and arrhythmias. 42 As for acetaminophen, the over-the-counter classification of diphenhydramine may lull medical practitioners and patients into underestimating this medication's adverse effects. It is important to consider toxicities when deciding whether to use this premedication before a transfusion.…”

Section: Risks Of Diphenhydraminementioning

confidence: 99%

Acetaminophen and Diphenhydramine Premedication for Allergic and Febrile Nonhemolytic Transfusion Reactions: Good Prophylaxis or Bad Practice?

Geiger¹,

Howard²

2007

Transfusion Medicine Reviews

115

111

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Febrile non-hemolytic and allergic reactions are the most common transfusion reactions, but usually do not cause significant morbidity. In an attempt to prevent these reactions, US physicians prescribe acetaminophen or diphenhydramine premedication before more than 50% of blood component transfusions. Acetaminophen and diphenhydramine are effective therapies for fever and allergy respectively, so their use in transfusion has some biologic rationale. However, these medications also have potential toxicity, particularly in ill patients, and in the studies performed to date, they have failed to prevent transfusion reactions. Whether the benefits of routine prophylaxis with acetaminophen and diphenhydramine outweigh their risks and cost requires re-examination, particularly in light of the low reaction rates reported at many institutions even when pre-medication is not prescribed.The most common acute adverse reactions to blood-component transfusions, febrile nonhemolytic transfusion reactions (FNHTRs) and allergic reactions, are fortunately among the least harmful. Blood recipients with FNHTRs experience fever (often defined as a temperature rise ≥ 1°C above baseline) and/or rigors within 3 hours of transfusion. Allergic reactions are most often associated with the development of urticaria or other rash, pruritus, wheezing, or angioedema within several hours of transfusion. 1-8 These reactions are temporally limited, self-resolving, and generally pose little risk of causing lasting harm. Mild reactions often consist of a limited increase of temperature without other symptoms or a localized urticarial exanthem. In moderate and severe reactions, rigors and fever may be severe with rapid onset and associated with other symptoms, and urticaria may be extensive and painful or include respiratory or other systemic symptoms.How an incipient urticarial or FNHTR will progress cannot be predicted on the basis of its initial presentation. Further, it is often not possible to distinguish the symptoms of mild reactions from early symptoms of other more consequential problems such as sepsis, hemolytic reactions, or anaphylaxis. Therefore, the earliest indication of a reaction mandates discontinuation of a transfusion and, except for the mildest urticarial reactions, its termination. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errorsmaybe discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Increased clinical and laboratory monitoring is necessary, and infusion of replacement blood may be required. Blood replacement is associated with additional transfusion-associated risks and may deplete low blood inventories. The development of repeated rea...

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Section: Risks Of Diphenhydraminementioning

confidence: 99%

Acetaminophen and Diphenhydramine Premedication for Allergic and Febrile Nonhemolytic Transfusion Reactions: Good Prophylaxis or Bad Practice?

Geiger¹,

Howard²

2007

Transfusion Medicine Reviews

115

111

View full text Add to dashboard Cite

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“…In previous reports, DPH overdose resulted in severe symptoms within several hours 5, 6. Symptoms are dose‐dependent.…”

Section: Discussionmentioning

confidence: 81%

“…Treatments for DPH overdose includes general condition management and symptomatic treatments, such as benzodiazepine (diazepam or midazolam) for convulsions, physostigmine for acetylcholinesterase inhibition, sodium bicarbonate for ventricular arrhythmia, and VA‐ECMO for hemodynamic collapse 4, 5, 9, 10. Although the patient died in this case, it is important to treat unstable hemodynamics with invasive auxiliary circulation such as VA‐ECMO.…”

Section: Discussionmentioning

confidence: 97%

Cardiac arrest caused by diphenhydramine overdose

Nishino

Wakai

Aoki

et al. 2018

Acute Medicine & Surgery

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CaseA 45‐year‐old man presented to our emergency department with disturbance of consciousness; he had mentioned to his family earlier about a drug overdose. When first responders arrived, he suffered cardiac arrest. Cardiac arrest due to drug overdose was diagnosed.The patient was supported with venoarterial extracorporeal membrane oxygenation. Arterial blood gas showed mixed acidosis, and electrocardiogram showed junctional rhythm and complete right bundle branch block.OutcomeThe patient's blood pressure gradually decreased, and he died on the third day of hospitalization. After death, his serum diphenhydramine concentration at the time of arrival was found to be 18.7 μg/mL.ConclusionAlthough diphenhydramine is regarded as a safe medication, it shows dose‐dependent toxicity. High intake is associated with death; therefore, caution should be exercised in cases of drug overdose. Developing a procedure for rapid measurement in the emergency department should be a priority.

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“…Sodium bicarbonate has been used to treat diphenhydramine overdoses resulting in QRS widening [2,65]. Sharma et al describe three cases of diphenhydramine toxicity with maximum QRS values ranging from 102 to 162 msec treated effectively with sodium bicarbonate [65].…”

Section: Other Sodium Channel Blocking Agentsmentioning

confidence: 99%

A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening

Bruccoleri

Burns

2015

J. Med. Toxicol.

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Sodium bicarbonate is a well-known antidote for tricyclic antidepressant (TCA) poisoning. It has been used for over half a century to treat toxin-induced sodium channel blockade as evidenced by QRS widening on the electrocardiogram (ECG). The purpose of this review is to describe the literature regarding electrophysiological mechanisms and clinical use of this antidote after poisoning by tricyclic antidepressants and other agents. This article will also address the literature supporting an increased serum sodium concentration, alkalemia, or the combination of both as the responsible mechanism(s) for sodium bicarbonate's antidotal properties. While sodium bicarbonate has been used as a treatment for cardiac sodium channel blockade for multiple other agents including citalopram, cocaine, flecainide, diphenhydramine, propoxyphene, and lamotrigine, it has uncertain efficacy with bupropion, propranolol, and taxine-containing plants.

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Diphenhydramine-induced wide complex dysrhythmia responds to treatment with sodium bicarbonate

Cited by 51 publications

References 11 publications

Acetaminophen and Diphenhydramine Premedication for Allergic and Febrile Nonhemolytic Transfusion Reactions: Good Prophylaxis or Bad Practice?

Acetaminophen and Diphenhydramine Premedication for Allergic and Febrile Nonhemolytic Transfusion Reactions: Good Prophylaxis or Bad Practice?

Cardiac arrest caused by diphenhydramine overdose

A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening

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