Venugopal K, Reddy M Mallikarjun, Bharathraj M Y, Jaligidad Kadappa, Kushal D P
Department of General Medicine, Vijayanagara Institute of Medical Sciences, Bellary, Karnataka, India.
Toxicol Int. 2014 Sep-Dec;21(3):319-21. doi: 10.4103/0971-6580.155384.
Pheniramine maleate is an easily accessible, over-the-counterantihistaminic, which is frequently involved in overdoses. Pheniramine has antimuscarinic effect causing tachycardia, dilated pupils, urinary retention, and dry flushed skin, and decreased bowel sounds, confusion, mild increase in body temperature, cardiac arrhythmias, and seizures at lethal doses. It has not been implicated as an important cause of rhabdomyolysis and acute kidney injury (AKI). Rhabdomyolysis causing AKI is rarely reported in the literature. This case report emphasizes the occurrence of nontraumatic rhabdomyolysis in pheniramine maleate overdose which required hemodialysis. Since there is a lack of a specific antidote, treatment is mainly symptomatic and supportive. We report a fatal case of a young male with a very high dose of consumption of pheniramine maleate (4.077 g), which was complicated by seizures, respiratory depression, nontraumatic rhabdomyolysis, and AKI. Despite hemodialysis, ventilator support, and other intensive supportive care, patient could not survive and death ensued due to multiorgan dysfunction syndrome.
马来酸氯苯那敏是一种容易获得的非处方抗组胺药，经常发生过量服用情况。氯苯那敏具有抗毒蕈碱作用，可导致心动过速、瞳孔散大、尿潴留、皮肤潮红干燥、肠鸣音减弱、意识模糊、体温轻度升高、心律失常，致死剂量时可出现癫痫发作。它尚未被认为是横纹肌溶解症和急性肾损伤（AKI）的重要病因。导致AKI的横纹肌溶解症在文献中鲜有报道。本病例报告强调了马来酸氯苯那敏过量服用时发生非创伤性横纹肌溶解症的情况，该患者需要进行血液透析。由于缺乏特效解毒剂，治疗主要是对症和支持治疗。我们报告了一例年轻男性因大量服用马来酸氯苯那敏（4.077 g）致死的病例，该病例并发癫痫发作、呼吸抑制、非创伤性横纹肌溶解症和AKI。尽管进行了血液透析、呼吸机支持及其他强化支持治疗，但患者仍因多器官功能障碍综合征未能存活而死亡。
