Advertisement
topic toxicology| Volume 2, ISSUE 6, P415-419, 1985

Atrioventricular block following overdose of decongestant cold medication

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      A 24-year-old man developed high-degree atrioventricular (A-V) block with a pulse rate of 40 beats per minute and hypertension following an overdose of a combination decongestant cold medication that contained phenylpropanolamine, phenylephrine, chlorpheniramine, and phenyltoloxamine. The patient was treated with ipecac, activated charcoal, and cathartics in the emergency department (ED). After his admission to the coronary care unit, the A-V block gradually resolved to sinus rhythm with periods of second-degree block, Mobitz types I and II. No treatment was required. The patient had a normal sinus rhythm and normal blood pressure prior to discharge.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bigger J.T.
        • Hoffman B.F.
        Antiarrhythmic drugs.
        in: Gilman A.G. Goodman L.S. Gilman A. The Pharmacological Basis of Therapeutics. 6th ed. Macmillan, New York1980: 761-792
        • Dauchot P.
        • Gravenstein J.S.
        Effects of atropine on the electrocardiogram in different age groups.
        Clin Pharmacol Ther. 1971; 12: 274-280
        • Hayes A.H.
        • Copelan H.W.
        • Ketchum J.S.
        Effects of large intramuscular doses of atropine on cardiac rhythm.
        Clin Pharmacol Ther. 1971; 12: 482-486
        • Zeis P.M.
        • Thanopoulos B.
        • Pierroutsakos I.N.
        • Koukoutsakis P.M.
        Complete atrioventricular block associated with propranolol therapy.
        J Pediatr. 1981; 98: 326-327
        • Timins B.I.
        • Gutman J.A.
        • Haft J.I.
        Disopyramide-induced heart block.
        Chest. 1981; 79: 477-479
        • Inoue H.
        • Takayanagi K.
        • Ueda K.
        • et al.
        Three cases of sinoatrial block induced by anticonvulsants.
        Jpn Heart J. 1978; 19: 544-551
        • Edwards A.C.
        • Meredith T.J.
        • Sowton E.
        Complete heart block due to chronic chloroquine toxicity managed with permanent pacemaker.
        Br Med J. 1978; 1: 1109-1110
        • Herman J.E.
        • Fleischmann P.
        Unusual evidence of myocardial involvement during a hypersensitivity reaction to oral penicillin.
        Israel J Med Sci. 1978; 14: 848-851
        • Williams P.L.
        • Krafcik J.M.
        • Potter B.B.
        • et al.
        Cardiac toxicity of clonidine.
        Chest. 1977; 72: 784-785
        • Cokkinos D.V.
        • Vorides E.M.
        Impairment of atrioventricular conduction by methyldopa.
        Chest. 1978; 74: 697
        • Jaffe C.M.
        First-degree atrioventricular block during lithium carbonate treatment.
        Am J Psychiatry. 1977; 134: 88-89
        • Akins D.
        • Awdeh M.R.
        Marijuana and second-degree A-V block.
        South Med J. 1981; 74: 371-372
        • Candell J.
        • Valle V.
        • Soler M.
        • Rius J.
        Acute intoxication with verapamil.
        Chest. 1979; 75: 200-201
        • Wren C.
        • Carson P.H.
        • Sanderson J.M.
        Organophosphate poisoning and complete heart block.
        J R Soc Med. 1981; 74: 688-689
        • Baldessarini R.J.
        Drugs and the treatment of psychiatric disorders.
        in: Gilman A.G. Goodman L.S. Gilman A. The Pharmacological Basis of Therapeutics. 6th ed. Macmillan, New York1980: 391-447
        • Silverman H.I.
        • Kreger B.E.
        • Lewis G.P.
        • et al.
        Lack of side effects from orally administered phenylpropanolamine and phenylpropanolamine with caffeine: A controlled three-phase study.
        Curr Ther Res. 1980; 28: 185-194
        • Weesner K.M.
        • Denison M.
        • Roberts R.J.
        Cardiac arrythmias in an adolescent following the ingestion of an over-the-counter stimulant.
        Clin Pediatr. 1982; 21: 700-701
        • Pentel P.R.
        • Mikell F.L.
        • Zavoral J.H.
        Myocardial injury after phenylpropanolamine ingestion.
        Br Heart J. 1982; 47: 51-54
        • Peterson R.B.
        • Vasquez L.A.
        Phenylpropanolamine-induced arrhythmias.
        JAMA. 1973; 223: 324-325
        • Frewin D.B.
        • Leonello P.P.
        • Frewin M.E.
        Hypertension after ingestion of trimolets.
        Med J Aust. 1978; 2: 497-498
        • Reyes-Jacang A.
        • Wenzl J.E.
        Antihistamine toxicity in children.
        Clin Pediatr. 1969; 8: 297-299
        • Johnson G.L.
        • Kahn J.B.
        Cocaine and antihistamine compounds: Comparison of effects of some cardiovascular actions of norepinephrine, tyramine and bretylium.
        J Pharm Exp Ther. 1966; 152: 458-468
        • Singh B.N.
        • Hanswirth O.
        Comparative mechanisms of action of antiarrhythmic drugs.
        Am Heart J. 1974; 87: 367-382
        • Krenzelok E.P.
        • Anderson G.M.
        • Mirick M.
        Massive diphenhydramine overdose resulting in death.
        Ann Emerg Med. 1982; 11: 212-213
        • Hestand H.E.
        • Teske D.W.
        Diphenhydramine hydrochloride intoxication.
        J Pediatr. 1977; 90: 1017-1018
        • Wyngaarden J.B.
        • Seevers M.H.
        The toxic effects of antihistaminic drugs.
        JAMA. 1951; 145: 277-282
        • James T.N.
        • Urthaler F.
        • Hageman G.R.
        Reflex heart block-baroreflex, chemoreflex and bronchopulmonary reflex causes.
        Am J Cardiol. 1980; 45: 1182-1188
        • Mancia G.
        • Bonazzi O.
        • Pozzoni L.
        • et al.
        Baroreceptor control of atrioventricular conduction in man.
        Circ Res. 1979; 44: 752-758
      1. Rumack B.H. Sympathomimetic management. 7th ed. Poisindex. Micromedex, Denver, CO1984
        • Rumack B.H.
        Anticholinergic poisoning: Treatment with physostigmine.
        Pediatrics. 1973; 52: 449