Makki Kassem, Mandil David, Hopson Roger, Kashin Maxim, Rothenberg Roger, Reisman Noah, Farmer Brenna
New York Presbyterian-Brooklyn Methodist Hospital, Division of Emergency Medicine.
New York Presbyterian-Brooklyn Methodist Hospital, Division of Internal Medicine, Pulmonary and Critical Care.
Clin Pract Cases Emerg Med. 2025 May;9(2):223-227. doi: 10.5811/cpcem.41491.
Diphenhydramine overdose is a growing concern, particularly among adolescents influenced by online challenges. Traditionally managed with supportive care and sodium bicarbonate, severe cases may exhibit refractory symptoms due to sodium channel toxicity, necessitating alternative treatments.
A 28-year-old male with a history of anxiety and depression presented to the emergency department unresponsive, next to an empty bottle of diphenhydramine and wine bottles. Vital signs indicated hypotension and hypoxia. The patient was intubated and administered vasopressors. Initial electrocardiogram (ECG) showed a widened QRS complex and terminal R wave in lead aVR, suggesting sodium channel blockade. Treatment with multiple boluses of sodium bicarbonate was ineffective. Lidocaine (95 milligrams intravenously) was administered, resulting in improved ECG findings and patient stabilization. Subsequent care focused on supportive measures and treatment for aspiration pneumonia. The patient was extubated on day two and discharged on day seven to a behavioral health facility.
This case underscores the effectiveness of lidocaine as a secondary treatment for diphenhydramine-induced sodium channel toxicity when standard sodium bicarbonate therapy fails. Lidocaine's ability to restore myocardial conduction illustrates its potential as a critical intervention in toxicological emergencies.
苯海拉明过量问题日益受到关注，尤其是在受网络挑战影响的青少年中。传统上采用支持性护理和碳酸氢钠进行治疗，但严重病例可能因钠通道毒性而出现难治性症状，因此需要替代治疗方法。
一名有焦虑和抑郁病史的28岁男性被送往急诊科，已失去意识，旁边有一瓶空的苯海拉明和一些酒瓶。生命体征显示低血压和低氧血症。患者接受了气管插管并使用了血管升压药。初始心电图（ECG）显示QRS波群增宽，aVR导联出现终末R波，提示钠通道阻滞。多次静脉注射碳酸氢钠治疗无效。给予利多卡因（静脉注射95毫克）后，心电图表现改善，患者病情稳定。后续护理重点是支持性措施及吸入性肺炎的治疗。患者在第二天拔管，第七天出院，转至行为健康机构。
本病例强调了在标准碳酸氢钠治疗失败时，利多卡因作为苯海拉明诱导的钠通道毒性的二线治疗方法的有效性。利多卡因恢复心肌传导的能力表明其在毒理学紧急情况中作为关键干预措施的潜力。
