Diphenhydramine toxicity: comparisons of postmortem findings in diphenhydramine-, cocaine-, and heroin-related deaths

The American Journal of Forensic Medicine and Pathology
S B Karch

Abstract

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 ...Continue Reading

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Citations

Oct 16, 2012·Forensic Science, Medicine, and Pathology·Lena EckesSven Hartwig
Feb 28, 2006·The American Journal of Forensic Medicine and Pathology·Jeffrey S Nine, Chad R Rund
Jun 6, 2006·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Elizabeth J ScharmanWilliam G Troutman
Jul 9, 2008·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Yoshito KamijoKatsuyoshi Kurihara
Oct 4, 2005·Emergency Medicine Clinics of North America·Joel T Levis, Gus M Garmel
Oct 22, 2013·Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Médicas E Biológicas·C S PlanetaC Scavone
Dec 13, 2019·Drug Metabolism Reviews·Kodye L AbbottSatyanarayana R Pondugula
Jul 23, 2014·The American Journal of Forensic Medicine and Pathology·Sabra Ruvera Botch-JonesJhonny Ordonez
Sep 13, 2019·American Journal of Therapeutics·Timothy NguyenJosh Renzo Ramilo

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