Fatality from Diphenhydramine Monointoxication

Abstract

As an antihistamine, diphenhydramine (DPH) is well known for its use in allergy treatment. Since its introduction in 1946, it has been marketed under various trade names, the most popular being Benadryl. Three years after its introduction, the first fatality due to DPH toxicity was reported in 1949. To better understand the incidence of fatalities due to DPH monointoxication, we reviewed deaths that were reported from 2 data sources: (1) the English-language literature using PubMed, from 1946 through 2003; and (2) the Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System (ARAAPCCTESS), from 1983 through 2002. The results were then tabulated using age, gender, clinicopathologic findings, and toxicology results. Combined results from both data sets show the following mean (and range) for age and DPH levels: Adult, 35.6 years (18-84) and 19.53 mg/L (0.087-48.5); pediatric, 8.6 years (1.25-17) and 7.4 mg/L (1.3-13.7); infant, 31 weeks (6 weeks-11 months) and 1.53 mg/L (1.1-2.2), respectively. Most deaths were certified as accident or suicide; however, 6 infant homicides were reported. The most common symptoms for all cases were cardiac dysrhythmias, seizure activity, and/or sympathetic pupil responses. The most common autopsy finding was pulmonary congestion.

Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children

“…It is also sold in higher dosage forms, ranging from 12.5 mg per 5 mL liquid formulations to 25 to 50 mg solid formulations. Significant diphenhydramine ingestion can lead to severe toxicity at 10 mg per 1 kg, with death reported as low as 11.6 mg per 1 kg in an infant 17–20 . As previously mentioned, all 3 deaths in our study were from diphenhydramine solid formulations.…”

“…Significant diphenhydramine ingestion can lead to severe toxicity at 10 mg per 1 kg, with death reported as low as 11.6 mg per 1 kg in an infant. [17][18][19][20] As previously mentioned, all 3 deaths in our study were from diphenhydramine solid formulations.…”

Survival after Diphenhydramine Ingestion with Hemodialysis in a Toddler

“…While serum concentrations do not directly correlate with toxicity [7], fatal diphenhydramine blood concentrations in pediatric ingestions have ranged from 69 to 12,100 ng/mL [8] (therapeutic range 100-1,000 ng/mL). The concentration of 3,900 ng/mL reported in our case was obtained 11.75 h after ingestion (and after 45 min of dialysis); this value is well within the range of concentrations at which fatalities have been reported.…”

A categorical review on electroanalytical determination of non-narcotic over-the-counter abused antitussive drugs

“…The drug is widely distributed throughout the body and the peak plasma concentration is attained in about 2-3 h after dosage, with 5-15% of a therapeutic dose of the drug excreted unchanged in human urine [34,35]. Being easily available, DPH is sometimes used as a recreational drug due to its euphoria and delirium-induced hallucination properties, which can be fatal in case of serious overdose [36,37].…”