BACKGROUND: Doxylamine is an over-the-counter drug that is popular in the treatment of insomnia. Doxylamine is relatively safe but can cause rhabdomyolysis. The aim of this study was to evaluate whether the incidence of rhabomyolysis increased in elderly patients (age> or =65 years) with doxylamine overdose. METHODS: This study included 108 patients admitted to an Emergency Department after doxylamine overdose between January 1, 2000, and March 31, 2013. Age, sex, time ingested before admission, amount of drug ingested, gastric lavage, tachycardia, vomiting, hematuria, blood urea nitrogen, blood creatinine, urine pH, and alcohol ingestion were investigated for the risk factors of rhabdomyolysis. RESULTS: Forty-three patients (47.6%) developed rhabdomyolysis. Of 16 elderly patients, 11 developed rhabdomyolysis. Of the 92 patients <65 years-of-age, 34 developed rhabdomyolysis. Advanced age, alcohol ingestion, and increased blood creatinine level were significantly associated with the development of rhabdomyolysis. CONCLUSION: In elderly patients with doxylamine overdose, the incidence rate of rhabdomyolysis may be increased. A high index of suspicion and evaluation of rhabdomyolysis is warranted in elderly patients with doxylamine overdose.
Aged* ; Blood Urea Nitrogen ; Creatinine ; Doxylamine* ; Eating ; Emergencies ; Gastric Lavage ; Hematuria ; Humans ; Hydrogen-Ion Concentration ; Incidence* ; Rhabdomyolysis* ; Risk Factors ; Sleep Initiation and Maintenance Disorders ; Tachycardia ; Vomiting

Social factors may affect the available sources of toxic substances and causes of poisoning; and these factors may change over time. Additionally, understanding the characteristics of patients with acute toxic poisoning is important for treating such patients. Therefore, this study investigated the characteristics of patients with toxic poisoning. Patients visiting one of 3 hospitals in 2003 and 2011 were included in this study. Data on all patients who were admitted to the emergency departments with acute toxic poisoning were retrospectively obtained from medical records. Total 939 patients were analyzed. The average age of patients was 40.0 +/- 20 yr, and 335 (36.9%) patients were men. Among the elements that did not change over time were the facts that suicide was the most common cause, that alcohol consumption was involved in roughly 1 of 4 cases, and that there were more women than men. Furthermore, acetaminophen and doxylamine remained the most common poisoning agents. In conclusion, the average patient age and psychotic drug poisoning has increased over time, and the use of lavage treatment has decreased.
Acetaminophen/poisoning ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking ; Child ; Child, Preschool ; Doxylamine/poisoning ; Emergency Service, Hospital/*statistics & numerical data ; Female ; Hospitals, University ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Poisoning/*epidemiology ; Retrospective Studies ; Sex Factors ; Suicide, Attempted ; Young Adult

Nausea and vomiting in pregnancy (NVP) is common medical condition during pregnancy and associated with hormonal change. Early recognition and active treatment is warranted because it can be associated with adverse healthy effect in both fetus and mother. First, the possibility of other gastrointestinal disorder should be considered and precipitating factor, renal and liver function should be evaluated. Primay recommended pharmacotherapy is the combination of oral pyridoxine hydrochloride and doxylamine succinate. Other options including dopamin (D2) receptor antagonist, antihistamine and serotonine 5 hydroxytryptamine 3-receptor (5-HT3) can be used. Fluid mixed with multivitamine including thiamine supplement should be considered in case of severe dehydration and hyperemesis gravidarum. Emotional support is also an important part in the management of NVP. The physician shoud apply individualized approach for the safest and most appripriate treatment.
Dehydration ; Doxylamine ; Female ; Fetus ; Humans ; Hyperemesis Gravidarum ; Liver ; Mothers ; Nausea ; Precipitating Factors ; Pregnancy ; Pyridoxine ; Serotonin ; Succinic Acid ; Thiamine ; Vomiting

PURPOSE: Doxylamine is commonly used for relief of insomnia; in addition, it is also a drug that is freguently used for intoxication in Korea. This drug is relatively safe; however, it is known to occasionally induce rhabdomyolysis. We have seen many cases of alcohol ingestion in doxylamine intoxications; however, few previous studies have documented the effects of alcohol on rhabdomyolysis. Therefore, the purpose of this study is to determine the effect of alcohol on rhabdomyolysis in doxylamine intoxicated patients. METHODS: This study was conducted on 91 patients admitted to an emergency department after doxylamine intoxication during the period from January 2001 to March 2012. Using the protocol developed beforehand, the amount of drug ingestion, past history, laboratory results, and whether or not alcohol was ingested were recorded. Rhabdomyolysis was defined as serum creatine kinase (CK) over 1,000 U/L. The SPSS package with logistic regression, t-test, and Fisher's test was used for analysis of data. RESULTS: Alcohol ingestion was detected in 52% of the study patients. The presence of hematuria and alcohol ingestion showed a significant association with development of rhabdomyolysis. CONCLUSION: Doxylamine intoxicated patients with alcohol ingestion may have a high rate of incidence of rhabdomyolysis. Therefore, doxylamine intoxicated patients who drink alcohol at the same time should be aware of rhabdomyolysis.
Creatine Kinase ; Doxylamine ; Eating ; Emergencies ; Hematuria ; Humans ; Incidence ; Korea ; Logistic Models ; Rhabdomyolysis

PURPOSE: Drug-induced non-cardiogenic pulmonary edema has been reported on in a drug case series. For most of the agents that cause pulmonary edema, the pathogenic mechanisms that are responsible for the pulmonary edema remain unknown. We report here on the cases of suspected drug-induced pulmonary edema and we analyze the clinical characteristics. METHODS: We reviewed the medical records of 1,345 patients who had drug adverse effects and drug poisoning from January 2005 to July 2010, and 480 of these patients were admitted to the EM Department. Among them, 17 patients developed abnormal chest radiological findings and they were analyzed for any clinical characteristics, the initial symptoms, securing the airway and the clinical results. RESULTS: Seventeen patients out of 480 (3.54%) developed drug-induced abnormal chest radiographic pulmonary edema; they displayed initial symptoms that included mental change (41.2%), dyspnea (17.6%), vomiting (11.8%), etc, and some displayed no symptoms at all (11.8%). Only 3 patients out of the 11 who died or had severe pulmonary edema were able to obtain an advanced airway prior to their arrival to the EM Department. Clinical recovery was generally rapid and this was mostly completed within 6 hours. The mortality rate was 11.8% (2 of 17 patients), and the causative drugs were found to be propofol (35.3%, 6 of 17 patients), multiple drugs (41.2% or 7 out of 17) and one patient each with ephedrine, ethylene glycol, doxylamine and an unknown drug, respectively. CONCLUSION: Drug-induced pulmonary edema and deaths are not uncommon, and recovery is typically rapid with few long-term sequelae when drug administration is discontinued. Oxygen therapy and securing the airway must be performed during transportation for patients with pulmonary edema.
Doxylamine ; Dyspnea ; Ephedrine ; Ethylene Glycol ; Ethylenes ; Humans ; Medical Records ; Oxygen ; Propofol ; Pulmonary Edema ; Thorax ; Transportation ; Vomiting

PURPOSE: Doxylamine is antihistamine drug that is used as a hypnotic. It is also used for suicidal attempts because it can be easily purchased at the pharmacy without a prescription. There were many articles about the complications after doxylamine intoxication such as a rhabdomyolysis, but only a few articles have reported on seizure. We reviewed the cases of doxylamine intoxication with seizure that were treated in the emergency department. METHODS: We reviewed the medical records of the patients who were over 15 years old and who were intoxicated by doxylamine at 3 emergency medical centers from January 2006 to June 2010. We reviewed the patients' age, gender, the dose of doxylamine ingested, if gastrointestinal decontamination was done, the time from intoxication to hospital arrival, the seizure history, treatment of seizure, the electroencephalography (EEG) results, the brain computed tomography (CT) results and the blood test results. RESULTS: There were 168 patients who were intoxicated by doxylamine during the study period. Twelve patients had a seizure episode. The differences between the patients who developed seizure and the patients who did not were the dose and the serum levels of sodium and creatinine. The only clinically meaningful difference was the amount of doxylamine. The amount of doxylamine ingested (>29 mg/kg) predicted the development of seizure with a sensitivity of 75% and a specificity of 92% on the ROC curve. One patient among the seizure patients expired in the emergency department. CONCLUSION: In case of doxylamine intoxicated patients, there is close relationship between seizure and ingested amount, so close observation needs to be done for the patients who ingest too much because doxylamine can cause death. Further prospective studies are needed for doxylamine intoxicated patients with a seizure episode.
Brain ; Creatinine ; Decontamination ; Doxylamine ; Electroencephalography ; Emergencies ; Hematologic Tests ; Humans ; Medical Records ; Pharmacy ; Prescriptions ; Rhabdomyolysis ; Risk Factors ; ROC Curve ; Seizures ; Sensitivity and Specificity ; Sodium

PURPOSE: The previous studies on H1 antihistamine overdose have generally been limited to cases of acute doxylamine succinate (DS) poisoning, yet there have been some studies on diphenhydramine (DPH) overdosing. But many clinicians consider the two drugs to be very similar and to have similar ingredients. The purpose of this study was to clarify the toxicologic characteristics and clinical outcomes between DS and DPH poisoning/overdose. METHODS: We reviewed the medical and intensive care records of the patients with acute DS or DPH poisoning and who admitted to our emergency department from January 2008 and April 2010. We collected patient information regarding the features of the poisoning and the clinical and demographic characteristics. The patients were assessed for the clinical outcomes, the GCS, the PSS (Poisoning Severity Score) and the SOFA (Sequential Organ Failure Assessment). RESULTS: Fifty seven patients (45 cases of DS poisoning and 12 cases of DPH poisoning) were enrolled. Compared with the DS group, the DPH group had higher incidences of intubation, serious mental change, QTc prolongation and ECG conduction abnormality (p=0.041, <0.001, 0.014 and 0.044, respectively). The DPH group had a higher PSS and a longer ICU stay. The peak CPK time and the CPK normalization time were longer for the patients with rhabdomyolysis due to DS poisoning. CONCLUSION: Two common H1 antihistamines, doxylamine and diphenhydramine, are in the same ethanolaminestructural class, but the toxico-clinical outcomes are different according to many aspects. Therefore, clinicians could take a careful approach for the differential diagnosis and management between DS and DPH poisoning.
Diagnosis, Differential ; Diphenhydramine ; Doxylamine ; Electrocardiography ; Emergencies ; Histamine Antagonists ; Humans ; Incidence ; Critical Care ; Intubation ; Rhabdomyolysis ; Succinic Acid

PURPOSE: The relationship between plasma concentration of doxylamine and rhabdomyolysis in doxylamine overdose has not yet been reported. The aim of this study was to determine if the plasma concentration of doxylamine can predict the occurrence of rhabdomyolysis. METHODS: We reviewed the medical records of patients whose plasma concentration of doxylamine were checked during a state of doxylamine overdose. Variables, including the measured concentration (Ct) of drug, were compared between the rhabdomyolysis and the non-rhabdomyolysis group. We calculated the hypothetical initial concentration (C0) based on first order pharmacokinetics and measurement of each patient's plasma concentration of doxylamine (Ct). C0 values were compared based on the occurrence of rhabdomyolysis. RESULTS: A total of 41 blood samples were taken; all were taken more than two hours after the ingestion of doxylamine. Of the 41, 14 of the subjects showed rhabdomyolysis and 15 of the subjects did not. The rest were excluded from the study. Average values of Ct and C0 in the rhabdomyolysis and non-rhabdomyolysis groups were, respectively, 4.18+/-5.17 mg/L Vs 4.18+/-2.23 mg/L, for Ct; 6.21+/-7.92 mg/L Vs 15.53+/-17.97 mg/L for C0. Ct levels between the two groups were not different (p=1.00), but the difference in C0 was marginally significant (p=0.08). Blood sampling time showed a significant difference between the two groups (p=0.03). CONCLUSION: We can not confirm a relationship of plasma doxylamine concentration and rhabdomyolysis but it appears that the development of rhabdomyolysis in doxylamine overdose has a tendency to increase at high plasma concentration.
Doxylamine ; Eating ; Humans ; Medical Records ; Plasma ; Rhabdomyolysis

PURPOSE: Doxylamine succinate is an over-the-counter drug commonly used in the treatment of insomnia. It is in the ethanolamine class of antihistamine and is frequently involved in intentional overdoses. Seizures are uncommon, but there are potentially serious complications, making early recognition and treatment essential. METHODS: We reviewed retrospectively the medical records of patients admitted for seizures after a doxylamine succinate overdose from Jan. 1, 1992 to Dec. 31, 2008. We evaluated them with respect to age, sex, amount ingested, clinical symptomatology, time from ingestion to seizure, complication, and prognosis. RESULTS: Among the 146 doxylamine overdose patients, 11 patients developed seizures. Females accounted for 9 (81.8%) patients and the number aged between 20 and 40 years was also 9 cases (81.8%). The average time from ingestion to emergency room visit was 170 minutes (60-360). The average time from ingestion to development of seizures was 188 minutes (60-480). The amount of doxylamine succinate ingested was 750-4,750 mg (mean = 2,425 mg). The frequent anticholinergic symptoms were tachycardia (63.6%), vomiting (45.5%), mydriasis (36.4%), and hypertension (36.4%). Rhabdomyolysis and drug induced hepatitis were observed in 7 cases (63.6%) and 6 cases (54.5%), respectively. Primary treatment included administration of benzodiazepine and conservative care. After more than a 6 month follow-up, no patients developed further seizure. CONCLUSIONS: The incidence of seizure after doxylamine succinate overdose is uncommon and prognosis is good. However, other serious symptoms are commonly combined, and we have to be aware that seizures are a potential complication and should be actively investigated and vigorously treated.
Aged ; Benzodiazepines ; Doxylamine ; Eating ; Emergencies ; Ethanolamine ; Female ; Follow-Up Studies ; Hepatitis ; Humans ; Hypertension ; Incidence ; Medical Records ; Mydriasis ; Prognosis ; Retrospective Studies ; Rhabdomyolysis ; Seizures ; Sleep Initiation and Maintenance Disorders ; Succinic Acid ; Tachycardia ; Vomiting

PURPOSE: Doxylamine succinate (DS) is frequently used to treat insomnia and it may induce rhabdomyolysis in the overdose cases. The purpose of this study is to evaluate the factors that can predict the serum creatine kinase (CK) level normalization time for patients with rhabdomyolysis due to DS ingestion. METHODS: This study was conducted on 71 patients who were admitted with rhabdomyolysis after DS ingestion during the period from January 2000 to July 2009. Rhabdomyolysis was defined as a serum CK level over 1,000 U/L. The collected data included the general characteristics, the anticholinergic symptoms, the ingested dose, the peak serum CK level, the time interval (TI) from the event to the peak CK level and the TI from the event to a CK level below 1,000 U/L. We evaluated the correlation between the patients'variables and the TI from the event to the peak CK level time and the time for a CK level below 1,000 U/L. RESULTS: The mean ingested dose per body weight (BW) was 30.86+/-18.63 mg/kg and the mean TI from the event to treatment was 4.04+/-3.67 hours. The TI from the event to the peak CK level was longer for the patients with a larger ingestion dose per BW (r=0.587, p<0.05). The CK normalization time was longer for the patients with a larger ingested dose per BW (r=0.446, p<0.05) and a higher peak CK level (r=0.634, p<0.05). CONCLUSION: The ingested dose per BW was correlated with the TI from the event to the peak CK level, and the ingested dose per BW and the peak CK level have significant correlations with the CK normalization time. These factors may be used to determine the discharge period of patients who had rhabdomyolysis following a DS overdose.
Body Weight ; Creatine ; Creatine Kinase ; Doxylamine ; Eating ; Humans ; Rhabdomyolysis ; Sleep Initiation and Maintenance Disorders ; Succinic Acid