Promethazine poisoning: clinical and electroencephalographic observations.

Abstract

Preliminary CommunicationsMRDIcM&s 31 acid output in women appears to be a reflection of their smaller lean body mass, an explanation previously suggested by Card and Marks (1960). Since the incidence of anacidity increases with age (Bockus, 1963), this relation between maximal acid output and lean body mass probably holds only for young healthy subjects. It is of interest that in spite of the negative conclusions reached by Baron (1964) Grossman, 1965; Sircus, 1965) further investigation of this group is obviously required.Studies are continuing with the aim of confirming and extending these results, and to determine whether the correlation between lean body mass and maximal acid output is sufficiently close in normal subjects to be able to define, and possibly predict, the acid output more accurately than is at present possible.SUMMARY Evidence is presented which shows that the maximal acid output of the stomach correlates with the lean body mass in both normal and duodenal ulcer subjects. The popular antihistamine promethazine hydrochloride (Phenergan) has useful sedative properties. In large dosage a toxic delirium may occur (Niedermeyer, 1956;James, 1958; Kjeldsberg, 1959), and four fatal cases have been recorded (Dommikovich, 1962;Mantz et al., 1964). A further case with an unusual clinical presentation is reported.CASE REPORT Three hours before admission a 12-year-old boy weighing 29.7 kg. complained of numbness and pain in the left leg. Within half an hour his speech became slurred and he was restless and excited. No significant illness preceded the attack, and access to dangerous drugs was denied.He was stuporous, incomprehensible, and frightened. Periods of violent spontaneous activity and agitation, with both visual and tactile hallucinations, alternated with shorter periods of inactivity. Extreme hyperaesthesia and hyperalgecia made it impossible even to record his temperature. The pupils were normal, all limbs moved freely, and plantar responses were extensor. His pulse was 120 and blood pressure 110/70 mm. Hg.After intramuscular chlorpromazine (25 mg.) the attacks of restlessness became less frequent, occurring about every five minutes. It now became possible to take his temperature (98.40 F.; 36.9' C.). Gradually long periods of sleep supervened.The first specimen of urine was pink and gave a positive phenothiazine reaction. Examination of the blood and urine 12 hours after admission revealed substances with absorption bands maximal at the same wavelength as promethazine. Twelve hours after admission he was drowsy but orientated and able to do simple arithmetic. He complained of a rippling sensation in the legs followed by obvious excitement. An electroencephalogram (E.E.G.) was taken ( Figs. 1 and 2).The tactile hallucinations gradually disappeared and the plantar responses became flexor 22 hours after the onset of symptoms. He had a dry mouth, stuffy nose, and sinus tachycardia for a further three days.On recovery the boy admitted taking eight promethazine tablets (200 mg.) seven and a half...

Prolonged Anticholinergic Delirium Following Antihistamine Overdose

“…The first was the large quantity of antihistamines, combined with her young age and low weight. However, previous reports of poisoning in children with promethazine 2 or cyproheptadine 3 – 5 have described delirium resolving within 48 hours.…”

Beyond the ‘purple drank’: Study of promethazine abuse according to the European Medicines Agency adverse drug reaction reports

“…Indeed, an anti-cholinergic toxidrome with hyperthermia, flushing, tachycardia, dry mucosa, mydriasis, urinary retention and gastrointestinal dysmotility has been described ( Burns and Boyer, 2013 ). In these cases, the mental state alteration is characterised by agitated delirium, with abnormal thoughts, irritability, distressing visual hallucinations, disorganised behaviour and insomnia ( Agnich et al, 2013 ; Cowen, 1979 ; Dollberg et al, 1989 ; Höjer and Tellerup, 2018 ; Leak and Carroll, 1967 ; Page et al, 2009 ; Scott et al, 2007 ; Timnak et al, 2004 ). With the promethazine-codeine cough syrup, ‘euphoric feelings’, ‘relaxation’, ‘slight giddiness and disorienting’, and ‘nice hallucinations’ have been described as well ( Bluelight.org [ 2020 ]; Erowid.org [ 2020 ]).…”