Fatal intoxication by dextromethorphan: A report on two cases

Rammer, Lennart; Holmgren, Per; Sandler, Håkan

doi:10.1016/0379-0738(88)90230-7

Cited by 58 publications

(16 citation statements)

References 3 publications

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“…25 Two fatalities in adults reported dextromethorphan concentrations of 3.3-9.2 g/L in blood. 26 Although there are limitations in interpreting postmortem drug concentrations in the blood and determining cause of death-especially in the context of limited data in children-the values in our report are elevated and definitely confirm that multiple substances were present in this infant's body at the time of death. Furthermore, we are unaware of any OTC cough and cold preparation that contains both pseudoephedrine and PPA, again confirming that this infant had been given at least 2 different preparations.…”

Section: Discussionsupporting

confidence: 58%

Toxicity of Over-the-Counter Cough and Cold Medications

Gunn¹,

Taha²,

Liebelt³

et al. 2001

Pediatrics

137

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ABSTRACT. Over-the-counter (OTC) cough and cold medications are marketed widely for relief of common cold symptoms, and yet studies have failed to demonstrate a benefit of these medications for young children. In addition, OTC medications can be associated with significant morbidity and even mortality in both acute overdoses and when administered in correct doses for chronic periods of time. Physicians often do not inquire about OTC medication use, and parents (or other caregivers) often do not perceive OTCs as medications. We present 3 cases of adverse outcomes over a 13-month period-including 1 death-as a result of OTC cough and cold medication use. We explore the toxicities of OTC cough and cold medications, discuss mechanisms of dosing errors, and suggest why physicians should be more vigilant in specifically inquiring about OTCs when evaluating an ill child. Pediatrics 2001;108(3). URL: http://www.pediatrics.org/cgi/content/full/108/3/e52; over-the-counter medications, cough and cold preparations, morbidity, mortality, phenylpropanolamine.ABBREVIATIONS. OTC, over-the-counter; PPA, phenylpropanolamine; ED, emergency department; PICU, pediatric intensive care unit; CBC, complete blood (cell) count; WBC, white blood cell (count); bpm, beats per minute; AAP, American Academy of Pediatrics; CNS, central nervous system; FDA, Food and Drug Administration. C olds, coughs, and upper respiratory infections are common childhood illnesses. The average child suffers from 6 to 10 colds per year, and each cold can last from 10 to 14 days, providing several days and nights of discomfort for the child as well as for his/her caregiver. 1 Many times parents will turn to one of many hundreds of cough and cold preparations for relief. However, over-the-counter (OTC) cough and cold preparations-although generally safe-have no demonstrated benefit. No studies have proven the efficacy of cough and cold preparations in facilitating recovery from these illnesses, 2-6 and most children will eventually improve on their own. However, a small number of children may suffer significant adverse effects from the administration of the very cough and cold formulations they were given in an attempt to relieve their symptoms. For example, the Food and Drug Administration recently issued an advisory to remove phenylpropanolamine (PPA)-a common constituent of OTC decongestants-from those products because of concern for increased risk of hemorrhagic stroke. 7,8 We present 3 cases of children who suffered significant morbidity from OTC cough and cold preparations requiring admission and treatment in a tertiary care hospital during a 13-month period; they ranged from a self-limited reaction requiring an intensive care unit admission to death in 1 patient. Because no cases of death or heart failure attributable to OTC cough and cold preparations have been reported in recent literature, these cases are presented to serve as points for additional discussion on the risks of OTC cough and cold preparations in children. CASE REPORTS Case 1A 36-month-old b...

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Section: Discussionsupporting

confidence: 58%

Toxicity of Over-the-Counter Cough and Cold Medications

Gunn¹,

Taha²,

Liebelt³

et al. 2001

Pediatrics

137

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“…Described reactions and associations using standard doses include dystonia, 40 anaphylaxis, 41 and bullous mastocytosis. 42 Accidental ingestions and overdoses are not uncommon, 3,43 and dependence, 44 psychosis, 45 mania, 46,47 hallucinations, 48 ataxia, 49,50 somnolence, 50 insulin-dependent diabetes, 51 and death 52 have been reported from high doses, particularly when DM is combined with other OTC medications. 53,54 DM is also a drug of abuse among adolescents.…”

Section: Discussionmentioning

confidence: 99%

Effect of Dextromethorphan, Diphenhydramine, and Placebo on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents

Paul¹,

Yoder

Crowell³

et al. 2004

Pediatrics

152

105

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ABSTRACT. Objectives. To determine whether the commonly used over-the-counter medications dextromethorphan and diphenhydramine are superior to placebo for the treatment of nocturnal cough and sleep difficulty associated with upper respiratory infections and to determine whether parents have improved sleep quality when their children receive the medications when compared with placebo.Methods. Parents of 100 children with upper respiratory infections were questioned to assess the frequency, severity, and bothersome nature of the nocturnal cough. Their answers were recorded on 2 consecutive days, initially on the day of presentation, when no medication had been given the previous evening, and then again on the subsequent day, when either medication or placebo was given before bedtime. Sleep quality for both the child and the parent were also assessed for both nights.Results. For the entire cohort, all outcomes were significantly improved on the second night of the study when either medication or placebo was given. However, neither diphenhydramine nor dextromethorphan produced a superior benefit when compared with placebo for any of the outcomes studied. Insomnia was reported more frequently in those who were given dextromethorphan, and drowsiness was reported more commonly in those who were given diphenhydramine.Conclusions. Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection. Furthermore, the medications given to children do not result in improved quality of sleep for their parents when compared with placebo. Each clinician should consider these findings, the potential for adverse effects, and the individual and cumulative costs of the drugs before recommending them to families. Pediatrics 2004;114:e85-e90. URL: http://www.pediatrics.org/cgi/content/full/114/ 1/e85; cough, upper respiratory infection, dextromethorphan, diphenhydramine, placebo.

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“…Kintz and Mangin [1992] reported the case of a patient who had died after consuming an unknown amount of DXM who had whole blood and urinary DXM concentrations of approximately 19 and 12 mM, respectively, postmortem. In two earlier cases of DXM overdose, blood DXM concentrations were 12 and 34 mM [Rammer et al, 1988]. To our knowledge, the plasma and urinary DXM levels of individuals who routinely consume large amounts of the drug have not been reported but it seems likely that DXM and DOR concentrations may very well reach micromolar concentrations [Wolfe and Caravati, 1995;Miller, 2005].…”

Section: Discussionmentioning

confidence: 92%

“…Recently DXM has become a popular drug of abuse and DXM toxicity is becoming an increasingly common problem. There are reports of individuals consuming as much as 2^3 g of DXM per day or more [Wolfe and Caravati, 1995;Miller, 2005] and a number of deaths have been attributed to overdose of DXM or DXM containing preparations [Rammer et al, 1988;Pender and Parks, 1991;Kintz and Mangin, 1992;Miller, 2005]. Dextromethorphan inhibits micturition in laboratory animals [Tillig and Constantinou, 2003] and the high doses of DXM consumed by some individuals raises the possibility that it may produce comparable e¡ects in humans.…”

Section: Introductionmentioning

confidence: 99%