Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York.
Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; St. John's University College of Pharmacy and Health Sciences, Jamaica, New York.
J Emerg Med. 2021 Sep;61(3):259-264. doi: 10.1016/j.jemermed.2021.04.020. Epub 2021 Jun 17.
Diphenhydramine, a first generation H histamine receptor antagonist, is a commonly used nonprescription medication that is used for the treatment of allergy, as a sleep aid, or combined with cough and cold remedies. Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is used commonly for analgesia. Although most cases of diphenhydramine or naproxen overdose require excellent supportive care only, meticulous attention should be given to cardiovascular and neurologic status.
A 22-year-old woman presented with altered mental status secondary to intentional ingestion of 240 combination caplets of naproxen sodium 220 mg and diphenhydramine hydrochloride 25 mg. While in the emergency department, she manifested a wide-complex tachycardia in the setting of hypotension that required repeated administration of sodium bicarbonate to overcome the sodium channel blockade caused by diphenhydramine. Aggressive potassium repletion was performed simultaneously. Her clinical course was complicated by status-epilepticus that required intubation. Orogastric lavage was performed, which returned blue pill slurry consistent with the ingested caplets. The patient was extubated on hospital day 2 and transferred to psychiatry thereafter. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In light of recent social media trends, such as the "Benadryl challenge" and its widespread availability, emergency providers should be familiar with diphenhydramine toxicity, especially the life-threatening neurologic consequences and risk of cardiovascular collapse. NSAIDs, such as naproxen, and other nonprescription analgesics are becoming more and more important in light of the current opioid crisis. There should be an emphasis on understanding these medications and their potential implications when taken in overdose.
苯海拉明，第一代 H 组胺受体拮抗剂，是一种常用的非处方药物，用于治疗过敏、作为助眠剂，或与咳嗽和感冒药联合使用。萘普生，一种非甾体抗炎药（NSAID），常用于止痛。虽然大多数苯海拉明或萘普生过量的情况仅需要良好的支持性治疗，但应仔细注意心血管和神经系统状态。
一名 22 岁女性因故意摄入 240 片萘普生钠 220 毫克和盐酸苯海拉明 25 毫克的组合胶囊而出现精神状态改变。在急诊科，她表现出低血压伴宽复合性心动过速，需要反复给予碳酸氢钠以克服苯海拉明引起的钠通道阻滞。同时进行了积极的补钾。她的临床过程复杂，伴有癫痫持续状态，需要插管。进行了经口胃管灌洗，返回与摄入的胶囊一致的蓝色药丸浆。患者在住院第 2 天拔管，随后转至精神病科。
为什么急诊医生应该注意这一点？鉴于最近的社交媒体趋势，如“苯海拉明挑战”及其广泛的可用性，急诊医生应该熟悉苯海拉明毒性，特别是危及生命的神经系统后果和心血管崩溃的风险。鉴于当前阿片类药物危机，萘普生等非处方止痛药和其他非处方止痛药变得越来越重要。应该强调了解这些药物及其在过量服用时的潜在影响。
