Korean Journal of Nephrology 1999;18(3):494-500.

Doxylamine 중독 후 발생한 횡문근융해증 4예 (A Case of Rhabdomyolysis due to Doxylamine Intoxication)

유종훈, 최의혁, 이정석, 홍수희, 권형주, 이무열, 박영우, 이철호, 서보정, 이동윤, 이준상 (Jong Hoon Yoo, Eui Hyuk Choi, Jeong Seok Lee, Su Hee Hong, Hyoung Ju Koun, Mu Yeul Lee, Young U Park, Chul Ho Lee, Bo Jeong Seo, Dong Yun Lee and Jun Sang Lee)

Abstract

Doxylamine is common over-the-counter sleep preparations & frequently involved in overdoses. The clinical course is dominated by the anticholinergic effects, including central nervous system & autonomic effects. We report 4 cases of suicide attempts in adults where ingestion of the doxylamines were complicated by rhabdomyolysis. They ingested doxylamines variable amount & were carried to emergency department. They complained gastrointestinal or central nervous system symptoms. Gastric lavages & administrations of activated charcoal were done. Creatine phosphok inase levels were normal or markedly elevated on arrival, but peaked several days later. Serum creatinine levels were normal. 99mTc-MDP bone scans were showed increased muscle labelling at the regions of muscle injury. They were treated with hydration, urine alkalinization, & supportive measures in hospital. On considering cause of rhabdomyolysis, our patients did not show any evidence of viral illness or coingestion of other potential myopathic toxins to support a secondary cause of rhabdomyolysis. The mechanism of rhabdomyolysis in cases of doxylamine overdose seems to be a direct toxic effect of the drug on striated muscle, but the exact mechanism is not clear. In all cases where such overdoses are suspected, consideration should be given to obtaining a urinalysis & a creatine phosphokinase level on arrival & creatine phosphokinase levels are carefully followed. Primary detoxication included gastric lavage & administration of activated charcoal. The patient's urine output & renal function should be closely monitored.