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Fatal diphenhydramine intoxication in infants

Andrew M Baker1, Deborah G Johnson, Joseph A Levisky

  • 1Office of the Armed Forces Medical Examiner, Rockville, Maryland, USA. andrew.baker@co.hennepin.mn.us

Journal of Forensic Sciences
|April 1, 2003
PubMed

Insights

Diphenhydramine (DPH) overdose can be fatal in infants, even at lower blood levels than in adults. This study details five infant fatalities linked to DPH, highlighting risks in young children.

Area of Science:

  • Pediatric Toxicology
  • Pharmacology
  • Forensic Pathology

Background:

  • Diphenhydramine (DPH) is a common over-the-counter antihistamine.
  • While generally safe for adults, DPH can cause paradoxical central nervous system stimulation in children.
  • Fatal intoxications in infants are rare but serious.

Observation:

  • This study presents five cases of fatal diphenhydramine intoxication in infants aged 6 to 12 weeks.
  • Postmortem blood DPH levels ranged from 1.1 to 1.6 mg/L.
  • Anatomic findings in all cases were unremarkable.

Findings:

  • Reported postmortem DPH levels in these infant fatalities are lower than those typically seen in adult fatal intoxications.
  • Two cases involved caregivers administering DPH to infants to induce sleep.
  • Two cases remain unsolved, and one is under investigation.

Implications:

  • These findings underscore the critical risk of diphenhydramine toxicity in infants.
  • Healthcare providers and caregivers must be aware of the potential for severe adverse events, including death, from DPH in young children.
  • This research supports the classification of these cases as fatal intoxications and calls for increased vigilance regarding DPH use in infants.

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