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Hydroxyzine-induced priapism.

Christopher Olson1, Archana Jhawar2, Zane Elfessi2

  • 1Jesse Brown VA Medical Center, 820 South Damen Avenue, Chicago, IL 60612, United States of America.

The American Journal of Emergency Medicine
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Summary
This summary is machine-generated.

Priapism, a painful erection, can be caused by hydroxyzine overdose. This case highlights the risk of intentional overdose leading to severe ischemic priapism requiring emergency treatment.

Keywords:
HydroxyzineIntentional overdosePriapismPsychiatryUrology

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Area of Science:

  • Urology
  • Emergency Medicine
  • Pharmacology

Background:

  • Priapism is a urologic emergency, with ischemic priapism being the most common subtype.
  • Medications with alpha-adrenergic properties, like hydroxyzine, can induce priapism.
  • Priapism from medication is typically associated with therapeutic doses, with overdose rarely reported.

Observation:

  • A case of a patient presenting with intentional overdose of hydroxyzine hydrochloride (200-600 mg) for insomnia.
  • The patient developed severe ischemic priapism with significant blood gas derangements in the corpora cavernosa.
  • Treatment involved aspiration and intracavernosal phenylephrine for detumescence.

Findings:

  • Intentional overdose of hydroxyzine can precipitate severe ischemic priapism.
  • This case presents the first report of hydroxyzine-induced priapism following an intentional overdose.
  • The patient's blood gas analysis revealed severe acidosis within the corpora cavernosa.

Implications:

  • Emergency physicians must consider hydroxyzine overdose as a potential cause of priapism.
  • Awareness of this association is crucial for prompt diagnosis and management of priapism.
  • This case underscores the importance of evaluating medication history in patients with priapism.