Syed Husnain, Som Sumit, Khan Nazia, Faltas Wael
Trinitas Hospital, Internal Medicine, 225 Williamson Ave, Elizabeth, New Jersey, 07207, USA.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0879. Epub 2009 Mar 17.
The present report highlights the possible adverse effects of doxylamine, a common over the counter sleep aid. Doxylamine is an antihistamine that at toxic doses can cause anticholinergic effects, including seizures, rhabdomyolysis and death. The following case describes a patient with doxylamine toxicity who presented with seizure and confusion. Our patient was managed symptomatically, and remained otherwise stable throughout his hospitalisation. This case is atypical in terms of a delayed rhabdomyolysis and a false positive urine drug screen test for methadone. There is evidence that doxylamine at toxic levels can lead to false positives for methadone and phencyclidine testing using immunoassay-based urine drug screen kits. Urine drug screen testing on patients who are hospitalised is typically performed using immunoassays. However, in certain cases confirmatory secondary testing may be required. Doxylamine is prone to abuse and knowledge of the clinical presentation of its toxicity and the management of acute overdose can be life-saving.
本报告重点介绍了多西拉敏（一种常见的非处方助眠药物）可能产生的不良反应。多西拉敏是一种抗组胺药，在中毒剂量时可引起抗胆碱能效应，包括癫痫发作、横纹肌溶解和死亡。以下病例描述了一名出现癫痫发作和意识模糊的多西拉敏中毒患者。我们的患者接受了对症治疗，在住院期间其他方面保持稳定。该病例在横纹肌溶解延迟出现以及美沙酮尿液药物筛查试验呈假阳性方面具有非典型性。有证据表明，使用基于免疫分析的尿液药物筛查试剂盒时，多西拉敏在中毒水平可导致美沙酮和苯环利定检测出现假阳性。住院患者的尿液药物筛查试验通常使用免疫分析法进行。然而，在某些情况下可能需要进行确证性二次检测。多西拉敏容易被滥用，了解其毒性的临床表现和急性过量的处理方法可能会挽救生命。
