Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2023; 11(16): 3870-3876
Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3870
High doses of dextromethorphan induced shock and convulsions in a 19-year-old female: A case report
Shintaro Shimozawa, Daisuke Usuda, Toru Sasaki, Shiho Tsuge, Riki Sakurai, Kenji Kawai, Shun Matsubara, Risa Tanaka, Makoto Suzuki, Yuta Hotchi, Shungo Tokunaga, Ippei Osugi, Risa Katou, Sakurako Ito, Suguru Asako, Kentaro Mishima, Akihiko Kondo, Keiko Mizuno, Hiroki Takami, Takayuki Komatsu, Jiro Oba, Tomohisa Nomura, Manabu Sugita
Shintaro Shimozawa, Daisuke Usuda, Shiho Tsuge, Riki Sakurai, Kenji Kawai, Shun Matsubara, Risa Tanaka, Makoto Suzuki, Yuta Hotchi, Shungo Tokunaga, Ippei Osugi, Risa Katou, Sakurako Ito, Suguru Asako, Kentaro Mishima, Akihiko Kondo, Keiko Mizuno, Hiroki Takami, Jiro Oba, Tomohisa Nomura, Manabu Sugita, Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
Toru Sasaki, Clinical Training Center, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
Takayuki Komatsu, Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo-city 113-8421, Tokyo, Japan
Author contributions: Shimozawa S wrote the manuscript; Sasaki T, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Hochi Y, Tokunaga S, Osugi I, Kato R, Ito S, Asako S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Ohba J and Nomura T assisted in writing the paper; Usuda D and Sugita M oversaw the entire process; all authors read and approved the final manuscript.
Informed consent statement: We obtained the necessary informed consent from the patient for publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shintaro Shimozawa, MD, Doctor, Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-city 177-8521, Tokyo, Japan. shin46260707@gmail.com
Received: February 24, 2023
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

We report the first case of shock caused by an overdose of dextromethorphan.

Keywords: Dextromethorphan, Drug overdose, Shock, Symptom, Treatment, Case report

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.