Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case Report
Introduction: 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 treat...
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2025-04-01
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| Series: | Clinical Practice and Cases in Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/2b49595b |
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| author | Kassem Makki David Mandil Roger Hopson Maxim Kashin Roger Rothenberg Noah Reisman Brenna Farmer |
| author_facet | Kassem Makki David Mandil Roger Hopson Maxim Kashin Roger Rothenberg Noah Reisman Brenna Farmer |
| author_sort | Kassem Makki |
| collection | DOAJ |
| description | Introduction: 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. Case Report: 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. Conclusion: 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. |
| format | Article |
| id | doaj-art-8d75071041144668a6cc35ef8a2a656d |
| institution | OA Journals |
| issn | 2474-252X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Clinical Practice and Cases in Emergency Medicine |
| spelling | doaj-art-8d75071041144668a6cc35ef8a2a656d2025-08-20T01:53:36ZengeScholarship Publishing, University of CaliforniaClinical Practice and Cases in Emergency Medicine2474-252X2025-04-019222322710.5811/cpcem.41491cpcem-9-223Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case ReportKassem Makki0David Mandil1Roger Hopson2Maxim Kashin3Roger Rothenberg4Noah Reisman5Brenna Farmer6New York Presbyterian-Brooklyn Methodist Hospital, Division of Emergency MedicineNew York Presbyterian-Brooklyn Methodist Hospital, Division of Emergency MedicineNew York Presbyterian-Brooklyn Methodist Hospital, Division of Internal Medicine, Pulmonary and Critical CareNew York Presbyterian-Brooklyn Methodist Hospital, Division of Internal Medicine, Pulmonary and Critical CareNew York University Langone Health, Division of ToxicologyNew York Presbyterian-Brooklyn Methodist Hospital, Division of Internal Medicine, Pulmonary and Critical CareNew York Presbyterian-Brooklyn Methodist Hospital, Division of Emergency MedicineIntroduction: 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. Case Report: 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. Conclusion: 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.https://escholarship.org/uc/item/2b49595b |
| spellingShingle | Kassem Makki David Mandil Roger Hopson Maxim Kashin Roger Rothenberg Noah Reisman Brenna Farmer Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case Report Clinical Practice and Cases in Emergency Medicine |
| title | Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case Report |
| title_full | Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case Report |
| title_fullStr | Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case Report |
| title_full_unstemmed | Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case Report |
| title_short | Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case Report |
| title_sort | lidocaine for sodium channel toxicity in diphenhydramine overdose case report |
| url | https://escholarship.org/uc/item/2b49595b |
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