![]() “Hot as a hare”: Rise in temperature due to decreased sweating. ANTIDOTE FOR IRON TOXICITY SKIN“Red as a beet”: Vasodilation sends blood to the skin to adjust for lack of sweating. ![]() “Dry as a bone”: Inhibition of muscarinic receptors in the sweat glands and salivary glands. “Mad as a hatter”: Inhibition of muscarinic receptors in the CNS leads to delirium, agitation, combativeness, confusion, restlessness, hallucinations, ataxia, tremor, seizures. There is also modest NMDA receptor antagonism (think PCP-like). Other overdose effects include blockade of sodium and perhaps potassium channels in the heart, which increases risk of seizures and arrhythmia. Elevated body temperature due to impaired heat dissipation is possible, especially in warm ambient environment. Ingested drugs may be more slowly absorbed, resulting in a delayed time to peak and longer course of toxicity than otherwise expected. These include tachycardia, dry flushed skin, dry mucous membranes, thick secretions, mydriasis, urinary retention, and quiet bowel. ![]() Rhabdomyolysis may result from prolonged physical agitation, particularly fighting against restraints.Ĭlassic peripheral anticholinergic symptoms may be overshadowed by the central effects. DPH crosses the blood brain barrier, accounting for the central anticholinergic syndrome of agitation, combativeness, delirium and hallucinations. Proper management is crucial because choosing the wrong treatment for certain toxic symptoms could result in fatal cardiac complications.ĭiphenhydramine is a first generation H 1-histamine receptor antagonist with prominent sedative and anticholinergic effects. The total for 2016 has nearly surpassed the total for 2015, and the year is not over yet.ĭiphenhydramine in overdose can cause significant toxicity. In subsequent years, the numbers declined by over half however, there was a 42% increase in DPH suicide gestures between 20. In 2013, there was a spike in diphenhydramine-related suicide exposures reported to the Missouri Poison Center (223 total). It is also being used more often in suicidal gestures. Unfortunately, diphenhydramine (DPH) is also abused recreationally for delirium and hallucinosis, particularly by teenagers and young adults, since it is cheap and easy to obtain. Proper management is crucial because choosing the wrong treatment for certain toxic symptoms could result in fatal cardiac complications. If someone drinks too much Benadryl ®, beware of a Diphenhydramine overdose because it can cause significant toxicity. The total for 2016 has nearly surpassed the total for 2015, and the year is not over yet. ![]() Unfortunately, the diphenhydramine (DPH) found in Benadryl ® can also be abused recreationally for delirium and hallucinosis, particularly by teenagers and young adults. It almost meets the old-fashioned definition of a cure-all. The drug comes in capsules, cough and cold preparations, and topicals. It treats allergies, itching, hives, URI symptoms, motion sickness, and insomnia. It is commonly known as Benadryl ® or Banophen ®. Used in conjunction with EDTA for lead poisoningĬhelation therapy more commonly used in childrenīest next step in management if you suspect acetaminophen intoxication yet have no lab results (it is a benign treatment)įirst sign of OD is hyperventilation and respiratory alkalosisįirst do an EKG, if wide QRS (in TCA overdose) then try sodium bicarbonateĭeprotonation of drugs causes improved urinary excretionĬan also be used in thyroid storm as iodine initially decreases thyroid hormone productionĮliminates amphetamines by acidifying urine which results in a charged amphetamine molecule which is excretedĪtropine blocks Ach receptors decreasing the effect of these drugs.Diphenhydramine is a ubiquitous OTC medicine found in almost everyone’s medicine cabinet. Only needed in moderate to severe lead poisoning Weak association with improve outcomes in scleroderma Used in the case of a radioactive incidentĪvoid in patients who have penicillin allergy Used in repeat transfusions that can cause iron overload (thalassemia) Used for aluminum poisoning in renal failure ![]()
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