A Case Of Non-traumatic Rhabdomyolysis In Doxylamine Overdose

Park, Sung Min; Lee, Jun Hong; Seong, Eun Young; Kang, Yang Ho; Lim, Jong Hoon; Lee, Soo Bong; Lee, Woo Chul; Lee, Chang Won; Kwak, Im Soo; Rha, Ha Youn

Abstract

Because doxylamine is an antihistamine commonly used as over-the counter sleep preparation, it may bring out overdose. The usual clinical course of the overdose is dominated by the anticholinergic effect of these agents; it include significant autonomic and central nervous system effect. The most frequent symptom included impaired consciousness, seizure, tachycardia, mydriasis and a psychosis similar to that in catatonic stupor. A serious complications may be rhadbomyolysis with subsequent impairment of renal function and acute renal failure. Though the exact mechaism is not clear yet, it seems likely that doxylamine has a direct toxic effect on striated muscle. We report a case of a 22-year-old man who was complicated by rhabdomyolysis and impairment of renal function after doxylamine overdose. He was transported due to reddish urine from other hospital. According to transfer note, when he arrived at emergency room, he had slight drowsy mental state without tonic clonic seizure. He developed a elevated muslce enzyme and showed generalized, multiple uptake in damages muscle with the image of 99MTc-MDP bone scan. He was managed with hydration, urine alkalinization and supportive care during hospitalization. If doxylamine overdose are suspected, we should obtain creatine kinase level. Recognition of the potential for rhabdomyolysis and institution of vigorous treatment may prevent acute renal failure in patients who have taken an overdose of the drug.