Dose-dependent toxicity of diphenhydramine overdose.

BACKGROUND: Diphenhydramine (DPHM) overdose is a frequent cause of acute poisoning. Although its clinical features are well known, information about the dose-dependent toxicity of DPHM is still scarce. The objective of this study was to investigate the dose-dependent toxicity of DPHM in patients with acute DPHM poisoning. METHODS: We have analyzed retrospectively all well-documented cases with DPHM monointoxications reported by physicians to the Swiss Toxicological Information Centre (STIC) between January 1984 and April 1996. In addition, a prospective study focusing on ingested DPHM doses and severity of symptoms was performed between May 1996 and December 1998. RESULTS: The retrospective and prospective studies included 232 and 50 patients with DPHM monointoxications, respectively. In both studies, mild symptoms (somnolence, anticholinergic signs, tachycardia, nausea/vomiting) occurred in 55-64%, moderate symptoms (isolated and spontaneously resolving agitation, confusion, hallucinations and ECG disturbances) in 22-27% and severe symptoms (delirium/psychosis, seizures, coma) in 14-18% of patients. Moderate symptoms occurred above ingested doses of 0.3 g DPHM. For severe symptoms the critical dose limit was 1.0 g DPHM. Although the frequency of delirium/psychosis remained constant or even decreased, coma and seizures were significantly (p<0.05) more frequent in the >1.5-g compared with the 1.0- to 1.5-g-dose group. CONCLUSIONS: These data demonstrate a clear dose-dependent acute toxicity of DPHM. They indicate that only patients with DPHM ingestions above 1.0 g are at risk for the development of severe symptoms and, therefore, should be hospitalized. Thus, the results contribute to the data basis required for a cost effective management of patients with DPHM overdose.

[The STIZ and the epidemiology of poisoning in Switzerland (Swiss Toxicologic Information Center)]. / Das STIZ und die Epidemiologie der Vergiftungen in der Schweiz.

Despite the fact that the danger and the sequelae of poisoning are regularly referred to in the media, comprehensive reports about type and frequency of poisoning in Switzerland are not available in the literature. Thus morbidity of poisoning can only be judged by the calls and written replies of treating physicians. According to the retrospective evaluation of the data available to us (1966 to 1991), the number of poisoning leading to severe life-threatening symptoms is tending to decline. This apparent success of prevention and treatment of poisoned patients in our country should be corroborated by extensively investigating quantitative and qualitative aspects of poisoning. Moreover, overall mortality of poisoning is increasing, especially because of the deaths caused by abusing habit-forming drugs. On the other hand, the number of suicides using medicaments shows a tendency to decline. Detailed statistical data about the circumstances and xenobiotics involved in poisoning could efficiently help to develop measures to prevent a fatal outcome.

[Poisoning with drugs, household products and plants in the case load of the Swiss Toxicologic Information Center]. / Vergiftungen mit Arzneimitteln, Haushaltprodukten und Pflanzen in der Kasuistik des Schweizerischen Toxikologischen Informationszentrums.

Intoxications with drugs, household products and plants include approximately 70% of all cases reported to the STIZ. Among drugs the most frequent severe intoxications occur with benzodiazepines and antidepressives; therefore, the toxicological risk of these substances are investigated in more detail. In children, accidental intoxications with household products are most frequent. In these cases special emphasis must be put on preventive measures. Plants only rarely lead to severe intoxications; however, if toxic symptoms do occur, the analysis of their causality and overall risk for the patient can be a difficult task and frequently requires the involvement of a plant specialist.

Online literature retrieval in poison control.

Modern bibliographic databases include an increasing number of substantial abstracts, as well as other features which contribute to their becoming useful additional tools in poison control. This paper is a contribution to the assessment of their respective value in providing rapid and up-to-date information about toxic effects of drugs and chemicals, as well as about the therapy of poisoning. The main systems compared are Excerpta Medica, Scisearch, and Toxline.

Outline literature retrieval in poison control.

As for the systems to choose, we would advocate to start with only one, in order to learn perfectly a first retrieval language. TOXLINE, at the time being, is probably the best choice. EXCERPTA MEDICA, on the other hand, if it can be made more up-to-date, could become a very important competitor. As for the most recent literature, SCISEARCH is likely to remain unbeatable.

[Deaths caused by poisoining in Switzerland]. / Todesfälle durch Vergiftung in der Schweiz.

In order to assess the mortality from poisoning in Switzerland, the medical certificates of death from the years 1972 to 1976 were analyzed. A comparison with earlier work shows that the overall mortality remains constant, with an increase of suicidal and a decrease of accidental and chronic poisoning. Most suicides are committed with drugs (especially hypnotics) and, mainly by men, with carbon monoxide (exhaust gas). Chronic fatal poisoning from the abuse of analgesics is lessening, at length, whereas death from hard drugs is on the increase. Fatal accidental poisoining is relatively rare in Switzerland. Among the victims are children, but adults as well, and particularly old people. Involved agents (carbon monoxide, drugs and medicines, technical and agricultural poisons, mushrooms) are pointed out with regard to prevention.

[Fatal kidney diseases due to analogesic abuse in Switzerland]. / Tödlich Nierenerkrankungen als Folge des Schmerzmittelmissbrauchs in der Schweiz

As part of an investigation into death by poisoning in Switzerland we were able to examine the register of deaths at the Swiss Federal Bureau of Statistics. All the medical reports which named analgesic nephropathy as being the basic illness and the main cause of death have been taken into consideration in this work. 331 deaths occurred in the five year period 1967-1971, and were studied as closely as the documents allowed. The earliest cases of death arose in the thirties, the maximum number however occurring between the age of 60 and 70. Between the onset of kidney damage and the actual death elapses a period of about 10 years. The ratio from woman to man is almost 2,8:1. The occurrence is particularly frequent among childless housewives. The victims are people of widely different occupations and social classes. The analgesic nephropathy resulting from addiction and leading to death is most frequently encountered among the population of the cities, and the German Swiss Cantons, as well as among people of protestant faith. The shocking number of 331 deaths in five years (in 1973 there were a further 79 cases) bears witness to the need for adequate preventive measures.