Document Detail

Diphenhydramine toxicity: comparisons of postmortem findings in diphenhydramine-, cocaine-, and heroin-related deaths.
MedLine Citation:
PMID:  9662109     Owner:  NLM     Status:  MEDLINE    
Diphenhydramine (DPH)-related deaths in adults are extremely rare, and detailed autopsy studies are rarer still. Toxicologic and anatomic findings in 4 cases of suicidal DPH overdose are described and compared with findings in a database of cocaine- and heroin-related deaths. Blood DPH levels were many times higher than those considered therapeutic (5000-35,000 ng/ml versus 50-100 ng/ml). Marked pulmonary edema with visceral congestion was a constant finding. Mean lung-body weight ratios for DPH, cocaine, heroin, and trauma controls were 0.015, 0.015, 0.019, and 0.013, respectively. When normalized for body weight in this fashion, edema in DPH-related deaths was comparable to that in cocaine-related deaths. Cardiac enlargement was apparent in 3 of the 4 DPH cases, 1 with marked myocardial fibrosis. The finding of increased heart size suggests that preexisting heart disease may provide the necessary substrate for lethal cases of DPH toxicity. Pulmonary edema in these cases remains unexplained, with edema in cases of heroin-related toxicity significantly worse than that produced by cocaine or DPH (p < .0001). Because DPH and cocaine can exert similar effects on the heart, a common mechanism may produce pulmonary edema in both. A different mechanism may account for heroin-related edema.
S B Karch
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Publication Detail:
Type:  Case Reports; Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of forensic medicine and pathology     Volume:  19     ISSN:  0195-7910     ISO Abbreviation:  Am J Forensic Med Pathol     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-09-11     Completed Date:  1998-09-11     Revised Date:  2011-02-02    
Medline Journal Info:
Nlm Unique ID:  8108948     Medline TA:  Am J Forensic Med Pathol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  143-7     Citation Subset:  IM    
Office of the Assistant Medical Examiner, City and County of San Francisco, California 94103, USA.
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MeSH Terms
Cardiomyopathy, Dilated / etiology,  pathology*
Cocaine / poisoning*
Diphenhydramine / analysis,  poisoning*
Fatal Outcome
Heroin / poisoning*
Middle Aged
Myocardium / pathology
Organ Size
Overdose / etiology,  pathology
Pulmonary Edema / etiology,  pathology*
Reg. No./Substance:
50-36-2/Cocaine; 561-27-3/Heroin; 58-73-1/Diphenhydramine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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