| Diphenhydramine toxicity: comparisons of postmortem findings in diphenhydramine-, cocaine-, and heroin-related deaths. | |
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MedLine Citation:
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PMID: 9662109 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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S B Karch |
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Publication Detail:
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Type: Case Reports; Comparative Study; Journal Article |
Journal Detail:
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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:
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Created Date: 1998-09-11 Completed Date: 1998-09-11 Revised Date: 2011-02-02 |
Medline Journal Info:
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Nlm Unique ID: 8108948 Medline TA: Am J Forensic Med Pathol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 143-7 Citation Subset: IM |
Affiliation:
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Office of the Assistant Medical Examiner, City and County of San Francisco, California 94103, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Cardiomyopathy, Dilated / etiology, pathology* Cocaine / poisoning* Diphenhydramine / analysis, poisoning* Fatal Outcome Female Fibrosis Heroin / poisoning* Humans Male Middle Aged Myocardium / pathology Organ Size Overdose / etiology, pathology Pulmonary Edema / etiology, pathology* Suicide |
| Chemical | |
Reg. No./Substance:
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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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