A Sleeping Pill Toxidrome

Author: Dineshbabu Baskaran / Editor: Jessie Lynch / Codes: Published: 28/08/2024

A 43-year-old gentleman with a background of anxiety and depression presents to the Emergency Department (ED) as his family have noted confusion, erratic eye movements and snoring. A number of empty packets have been found in his bedroom, with a total of 120 50mg Nytol (diphenhydramine) tablets missing a total of 6 grams of diphenhydramine.

Examination findings are as follows:

Airway: Snoring this improves with insertion of a nasopharyngeal airway

Breathing: Respiratory rate 32 breaths/minute, oxygen saturations 97% on 15 litres of oxygen via non-rebreather mask, chest clear on auscultation

Circulation: Heart rate (HR) 138 beats/minute, regular rhythm, blood pressure (BP) 141/94mm Hg, warm peripheries

Disability: GCS 11/15, E4V2M5, agitated, pupils 5mm bilaterally and reacting to light, no lateralizing signs.

Exposure: Afebrile, palpable bladder 1000mls of clear urine drain on catheterisation.

Leave a Reply