Journal Published Online: 01 March 2003
Volume 48, Issue 2

Fatal Diphenhydramine Intoxication in Infants

CODEN: JFSCAS

Abstract

Diphenhydramine is an antihistamine available in numerous over-the-counter preparations. Often used for its sedative effects in adults, it can cause paradoxical central nervous system stimulation in children, with effects ranging from excitation to seizures and death.

Reports of fatal intoxications in young children are rare. We present five cases of fatal intoxication in infants 6, 8, 9, 12, and 12 weeks old. Postmortem blood diphenhydramine levels in the cases were 1.6, 1.5, 1.6, 1.1 and 1.1 mg/L, respectively. Anatomic findings in each case were normal. In one case the child's father admitted giving the infant diphenhydramine in an attempt to induce the infant to sleep; in another case, a daycare provider admitted putting diphenhydramine in a baby bottle. Two cases remain unsolved; one case remains under investigation.

The postmortem drug levels in these cases are lower than seen in adult fatalities. We review the literature on diphenhydramine toxicity, particularly as it pertains to small children, and discuss the rationale for treating these cases as fatal intoxications.

Author Information

Baker, AM
Office of the Armed Forces Medical Examiner, Rockville, Maryland
Johnson, DG
Office of the El Paso County Coroner, Colorado Springs, Colorado
Levisky, JA
Office of the El Paso County Coroner, Colorado Springs, Colorado
Hearn, WL
Miami-Dade County Medical Examiner Department, Miami, Florida
Moore, KA
Office of the Chief Medical Examiner, Baltimore, Maryland
Levine, B
Office of the Armed Forces Medical Examiner, Rockville, Maryland Office of the Chief Medical Examiner, Baltimore, Maryland
Nelson, SJ
District 10 Medical Examiner, Bartow, Florida
Pages: 4
Price: $25.00
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Stock #: JFS2002121
ISSN: 0022-1198
DOI: 10.1520/JFS2002121