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Rhabdomyolysis and Acute Renal Failure Following an Ethanol and Diphenhydramine Overdose

Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY; Medical Research Services, VA Western NY Healthcare System, Buffalo; Department of Surgery, School of Medicine and Biological Sciences, University at Buffalo

Yanina Magram, PharmD

Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo

Archana Mishra, MD MS

Department of Medicine, Erie County Medical Center, Buffalo

Reprints: Curtis E Haas PharmD, University at Buffalo, 311 Hochstetter Hall, Buffalo, NY 14260-1200, FAX 716/645-2886, E-mail haas{at}buffalo.edu

OBJECTIVE: To report a case of nontraumatic rhabdomyolysis complicated by oliguric, acute renal failure following an intentional overdose of ethanol and diphenhydramine.

CASE SUMMARY: A 21-year-old white man was admitted through the emergency department following an intentional overdose of ethanol and diphenhydramine. The patient subsequently developed acute renal failure, and a diagnosis of nontraumatic rhabdomyolysis was made. With the absence of other common causes in this case, the rhabdomyolysis was believed to be due to the combined ethanol and diphenhydramine overdose.

DISCUSSION: Rhabdomyolysis is a severe and life-threatening syndrome caused by various insults to skeletal muscle, including drug-induced injury. Early detection and institution of effective treatments are essential to minimizing the complications of this syndrome. A delay in establishing the diagnosis in this case likely contributed to the severity of the renal failure.

CONCLUSIONS: Nontraumatic rhabdomyolysis is an uncommon adverse outcome of drug and toxin ingestion. Due to the potential severity of the complications of this syndrome and the importance of early recognition and treatment to prevent renal failure, clinicians should have a high index of suspicion for rhabdomyolysis following overdoses that involve alcohol or antihistamines.

Key Words: diphenhydramine, ethanol, rhabdomyolysis

Published Online, February 20, 2003. www.theannals.com, DOI 10.1345/aph.1C241

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