Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3870
Peer-review started: February 24, 2023
First decision: March 24, 2023
Revised: April 14, 2023
Accepted: May 4, 2023
Article in press: May 4, 2023
Published online: June 6, 2023
Dextromethorphan is a prevalent antitussive agent that can be easily obtained as an over-the-counter medication. There has been a growing number of reported cases of toxicity in recent years. Generally, there are numerous instances of mild symptoms, with only a limited number of reports of severe cases necessitating intensive care. We presented the case of a female who ingested 111 tablets of dextromethorphan, leading to shock and convulsions and requiring intensive care that ultimately saved her life.
A 19-year-old female was admitted to our hospital via ambulance, having overdosed on 111 tablets of dextromethorphan (15 mg) obtained through an online importer in a suicide attempt. The patient had a history of drug abuse and multiple self-inflicted injuries. At the time of admission, she exhibited symptoms of shock and altered consciousness. However, upon arrival at the hospital, the patient experienced recurrent generalized clonic convulsions and status epilepticus, necessitating tracheal intubation. The convulsions were determined to have been caused by decreased cerebral perfusion pressure secondary to shock, and noradrenaline was administered as a vasopressor. Gastric lavage and activated charcoal were also administered after intubation. Through systemic management in the intensive care unit, the patient’s condition stabilized, and the need for vasopressors ceased. The patient regained consciousness and was extubated. The patient was subsequently transferred to a psychiatric facility, as suicidal ideation persisted.
We report the first case of shock caused by an overdose of dextromethorphan.
Core Tip: Prior studies have posited that dextromethorphan acts as a voltage-gated calcium channel inhibitor, one of its mechanisms of action. It is possible that the high dose in the present case amplified this effect. Previous reports attributed fatalities to central nervous system and respiratory depression, yet shock may also be a contributing factor, as evidenced by this case. This may be a rare occurrence, as it was only observed in the emergency room. We reported the first case of shock caused by an overdose of dextromethorphan. We were able to save the patient’s life in intensive care.