Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan.
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
J Int Med Res. 2023 Oct;51(10):3000605231205449. doi: 10.1177/03000605231205449.
Drug overdose can lead to a range of symptoms, including potentially life-threatening cardiac arrhythmias. However, identifying the specific causative drug upon admission can be challenging in many cases. The toxidrome approach is a method that utilizes toxidromes, which are collections of findings obtained from physical examination and ancillary tests, that may be caused by a specific toxin. In this particular case, a man presented with an unknown drug overdose that caused symptoms indicative of anticholinergic effects and abnormal electrocardiogram (ECG) findings. The ECG revealed an R wave in lead aVR, S waves in leads I and aVL, and wide QRS tachycardia with a Brugada pattern. Shortly after arrival, the patient developed cardiac arrest due to a lethal arrhythmia. Prompt initiation of venoarterial extracorporeal cardiopulmonary membrane oxygenation (VA-ECMO) was performed. Fortunately, the patient achieved full neurological recovery, and the overdosed drug was identified as diphenhydramine. When diagnosing and treating drug overdose caused by an unidentified substance, diphenhydramine toxicity should be considered when an anticholinergic toxidrome is present and a Brugada pattern is observed on the ECG. VA-ECMO demonstrates potential as a viable treatment option when initial interventions prove ineffective.
药物过量可导致一系列症状,包括潜在危及生命的心律失常。然而,在许多情况下,入院时确定导致中毒的确切药物具有挑战性。中毒症候群方法是一种利用中毒症候群的方法,中毒症候群是从体检和辅助检查中获得的一系列发现,可能是由特定毒素引起的。在这种特殊情况下,一名男子出现了不明原因的药物过量,导致出现提示抗胆碱能作用和异常心电图(ECG)表现的症状。ECG 显示 aVR 导联的 R 波、I 和 aVL 导联的 S 波以及宽 QRS 心动过速伴 Brugada 图形。到达后不久,患者因致命性心律失常发生心脏骤停。立即开始进行静脉动脉体外心肺膜氧合(VA-ECMO)。幸运的是,患者完全恢复了神经功能,过量的药物被确定为苯海拉明。当诊断和治疗由不明物质引起的药物过量时,如果存在抗胆碱能中毒症候群并且在 ECG 上观察到 Brugada 图形,则应考虑苯海拉明毒性。当初始干预无效时,VA-ECMO 作为一种可行的治疗选择具有潜力。