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Life-threatening pediatric dextromethorphan polistirex overdose
Justin A Seltzer1, Sarika K Sheth2, Sarah Friedland2
1Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA, United States of America; VA San Diego Healthcare System, San Diego, CA, United States of America; Rady Children's Hospital San Diego, San Diego, CA, United States of America.
The American Journal of Emergency Medicine
|August 21, 2022
Summary
Dextromethorphan polistirex overdose in a toddler caused severe symptoms, requiring intubation. A blood concentration over 100 ng/mL may indicate toxicity in pediatric patients.
Area of Science:
- Toxicology
- Pharmacology
- Pediatrics
Background:
- Dextromethorphan polistirex is an extended-release formulation of dextromethorphan hydrobromide.
- This formulation offers a prolonged duration of action compared to standard dextromethorphan.
- The polistirex binder slows drug release, but liberated dextromethorphan has unchanged pharmacokinetics.
Observation:
- A 23-month-old male ingested 900 mg of dextromethorphan polistirex.
- The child presented with unresponsiveness, tachycardia, hypertension, mydriasis, and opisthotonos.
- Intubation was required for airway protection due to symptoms.
Findings:
- Blood dextromethorphan concentration was 110 ng/mL, significantly above the therapeutic range (10-40 ng/mL).
- The patient was extubated after 13 hours and discharged the same day.
- This case suggests blood dextromethorphan concentrations exceeding 100 ng/mL can be toxic in young children.
Implications:
- Life-threatening dextromethorphan polistirex overdoses are rare in children.
- The toxic dose and blood concentration for this formulation in pediatrics are not well-defined.
- Further research is needed to establish toxicity thresholds for dextromethorphan polistirex in pediatric populations.
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