A 25-Year-Old Woman with Continues Unconsciousness For 10 Days: A Case Report and Review of Literature
Abstract
We reported the case of a 25-year-old woman with antihistamine abuse who presented to our hospital with a GCS of 7 and no significant past medical, psychological, or allergic history. We couldn’t find any evidence of head trauma, seizures, suicide, or any other metabolic, infectious, intoxication, or electrolyte disturbances. During her 10-day admission, the patient developed non-specific manifestations such as fever, hyperthermia, agitation, hypotension, and sinus tachycardia. Physicians should always consider over-the-counter medicines such as antihistamines as a differential diagnosis for loss of consciousness in patients who do not have any footprints of intoxication in primary urine or blood tests.
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[12] De Paepe P, Lemoyne S, Buylaert W. Disorders of consciousness induced by intoxication. Neurol Clin. 2012;30(1):359-384, x-xi. https://doi.org/10.1016/j.ncl.2011.10.003
[13] Amorim RLOd, Nagumo MM, Paiva WS, Andrade AFd, Teixeira MJ. Current clinical approach to patients with disorders of consciousness. Rev Assoc Med Bras. 2016;62(4):365-372. https://doi.org/10.1590/1806-9282.62.04.377
[14] Cooksley T, Rose S, Holland M. A systematic approach to the unconscious patient. Paediatr Child Health. 2021;31(4):153- 162.
[15] Holland J, Brown R. Acute presentation of altered conscious state. Paediatr Child Health. 2021;31(4):153-162. https://doi. org/10.1016/j.paed.2021.01.005
[16] Kim KT, Jeon JC, Jung C-G, Park JA, Seo J-G, Kwon DH. Etiologies of altered level of consciousness in the emergency room. Scientific Reports. 2022;12(1):4972. https://doi.org/10.1038/ s41598-022-09110-2
[17] Holstege CP, Borek HA. Toxidromes. Critical care clinics. 2012;28(4):479-98. https://doi.org/10.1016/j.
ccc.2012.07.008
[18] Kurdil N. Diagnosis of acute poisoning by addictive and psychotropic substances based on the toxidrome. EMERGENCY MEDICINE. 2021;17(3):39-46. https://doi.org/10.22141/2224- 0586.17.3.2021.234804
[19] Noyan MA, Elbi H, Aksu H. Donepezil for anticholinergic drug intoxication: a case report. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2003;27(5):885-7. https://doi.org/10.1016/S0278-5846(03)00119-2
[20] KaramiZadeh K. The Effect of Baclofen on the Reduction of the Level of Consciousness: A Case Report. Yafteh. 2020;22(1).
[21] Verdu E, Blanc-Brisset I, Meyer G, Le Roux G, Bruneau C, Deguigne M. Second-generation antihistamines: a study of
poisoning in children. Clinical toxicology. 2020;58(4):275-83. https://doi.org/10.1080/15563650.2019.1634812
[22] Tashiro M, Mochizuki H, Iwabuchi K, Sakurada Y, Itoh M, Watanabe T, et al. Roles of histamine in regulation of arousal and cognition: functional neuroimaging of histamine H1 receptors in human brain. Life Sciences. 2002;72(4):409-14. https://doi.org/10.1016/S0024-3205(02)02276-2
[23] Thomas SHL. Antihistamine poisoning. Medicine. 2016;44(3):141-2. https://doi.org/10.1016/j.mpmed.2015.12.002
[24] Jeffery AD, Lytle-Saddler T. Diphenhydramine overdose in a 26-year-old woman. Journal of emergency nursing.
2008;34(6):543-4. https://doi.org/10.1016/j.jen.2007.12.004
[25] Mohan S, Backus T, Furlano E, Howland MA, Smith SW, Su MK. A Case of Massive Diphenhydramine and Naproxen Overdose. (0736-4679 (Print)).
[26] Renko A, Cortese T, Karagiannis P, Salzman M. Unintentional cetirizine overdose causing anticholinergic
syndrome. The American Journal of Emergency Medicine. 2022;52:270.e1-.e3. https://doi.org/10.1016/j. ajem.2021.08.062
[2] Eapen BC, Georgekutty J, Subbarao B, Bavishi S, Cifu DX. Disorders of consciousness. Phys Med Rehabil Clin N Am. 2017;28(2):245-258. https://doi.org/10.1016/j. pmr.2016.12.003
[3] Thibaut A, Schiff N, Giacino J, Laureys S, Gosseries O. Therapeutic interventions in patients with prolonged disorders of consciousness. Lancet Neurol. 2019;18(6):600-614. https://doi.org/10.1016/S1474-4422(19)30031-6
[4] Posner JB, Saper CB, Schiff N, Plum F. Plum and Posner’s Diagnosis of Stupor and Coma. Oxford University Press; 2008. https://doi.org/10.1093/med/9780195321319.001.0001
[5] Samuels MA. The Evaluation of Comatose Patients. Hosp Pract. 1993;28(3):165-182. https://doi.org/10.1080/2154833
1.1993.11442770
[6] Buylaert W. Coma induced by intoxication. Acta Neurol Belg. 2000;100(4):221-224.
[7] Weiss N, Regard L, Vidal C, Luque Y, Taldir G, Vallet H, et al. Causes of coma and their evolution in the medical intensive care unit. J Neurol. 2012;259 (7):1474-1477. https://doi. org/10.1007/s00415-011-6388-z
[8] Taghaddosinejad F, Sheikhazadi A, Yaghmaei A, Mehrpour O, Schwake L. Epidemiology and treatment of severe poisoning in the intensive care unit: lessons from a one-year prospective observational study. J Clin Toxicol. 2012;1(Suppl 1):007.
[9] Finkelstein Y, Macdonald EM, Hollands S, Sivilotti ML, Hutson JR, Mamdani MM, et al. Risk of suicide following deliberate self-poisoning. JAMA Psychiatry. 2015;72(6):570-575. https:// doi.org/10.1001/jamapsychiatry.2014.3188
[10] Orsini J, Din N, Elahi E, Gomez A, Rajayer S, Malik R, et al. Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU. J Community Hosp Intern Med Perspect. 2017;7(4):202-207. https://doi.org/10.1080/2 0009666.2017.1356189
[11] Kim KT, Jeon JC, Jung CG, Park JA, Seo JG, Kwon DH. Etiologies of altered level of consciousness in the emergency room. Sci Rep. 2022;12(1):4972. https://doi.org/10.1038/s41598-022- 09110-2
[12] De Paepe P, Lemoyne S, Buylaert W. Disorders of consciousness induced by intoxication. Neurol Clin. 2012;30(1):359-384, x-xi. https://doi.org/10.1016/j.ncl.2011.10.003
[13] Amorim RLOd, Nagumo MM, Paiva WS, Andrade AFd, Teixeira MJ. Current clinical approach to patients with disorders of consciousness. Rev Assoc Med Bras. 2016;62(4):365-372. https://doi.org/10.1590/1806-9282.62.04.377
[14] Cooksley T, Rose S, Holland M. A systematic approach to the unconscious patient. Paediatr Child Health. 2021;31(4):153- 162.
[15] Holland J, Brown R. Acute presentation of altered conscious state. Paediatr Child Health. 2021;31(4):153-162. https://doi. org/10.1016/j.paed.2021.01.005
[16] Kim KT, Jeon JC, Jung C-G, Park JA, Seo J-G, Kwon DH. Etiologies of altered level of consciousness in the emergency room. Scientific Reports. 2022;12(1):4972. https://doi.org/10.1038/ s41598-022-09110-2
[17] Holstege CP, Borek HA. Toxidromes. Critical care clinics. 2012;28(4):479-98. https://doi.org/10.1016/j.
ccc.2012.07.008
[18] Kurdil N. Diagnosis of acute poisoning by addictive and psychotropic substances based on the toxidrome. EMERGENCY MEDICINE. 2021;17(3):39-46. https://doi.org/10.22141/2224- 0586.17.3.2021.234804
[19] Noyan MA, Elbi H, Aksu H. Donepezil for anticholinergic drug intoxication: a case report. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2003;27(5):885-7. https://doi.org/10.1016/S0278-5846(03)00119-2
[20] KaramiZadeh K. The Effect of Baclofen on the Reduction of the Level of Consciousness: A Case Report. Yafteh. 2020;22(1).
[21] Verdu E, Blanc-Brisset I, Meyer G, Le Roux G, Bruneau C, Deguigne M. Second-generation antihistamines: a study of
poisoning in children. Clinical toxicology. 2020;58(4):275-83. https://doi.org/10.1080/15563650.2019.1634812
[22] Tashiro M, Mochizuki H, Iwabuchi K, Sakurada Y, Itoh M, Watanabe T, et al. Roles of histamine in regulation of arousal and cognition: functional neuroimaging of histamine H1 receptors in human brain. Life Sciences. 2002;72(4):409-14. https://doi.org/10.1016/S0024-3205(02)02276-2
[23] Thomas SHL. Antihistamine poisoning. Medicine. 2016;44(3):141-2. https://doi.org/10.1016/j.mpmed.2015.12.002
[24] Jeffery AD, Lytle-Saddler T. Diphenhydramine overdose in a 26-year-old woman. Journal of emergency nursing.
2008;34(6):543-4. https://doi.org/10.1016/j.jen.2007.12.004
[25] Mohan S, Backus T, Furlano E, Howland MA, Smith SW, Su MK. A Case of Massive Diphenhydramine and Naproxen Overdose. (0736-4679 (Print)).
[26] Renko A, Cortese T, Karagiannis P, Salzman M. Unintentional cetirizine overdose causing anticholinergic
syndrome. The American Journal of Emergency Medicine. 2022;52:270.e1-.e3. https://doi.org/10.1016/j. ajem.2021.08.062
| Files | ||
| Issue | Vol 9 No 1 (2024): January-February | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v9i1.16823 | |
| Keywords | ||
| Anti-histamine abuse Unconsciousness | ||
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How to Cite
1.
Ghasemi MS, Shajari R. A 25-Year-Old Woman with Continues Unconsciousness For 10 Days: A Case Report and Review of Literature. CRCP. 2024;9(1):10-16.
