Dextromethorphan Overdose with Refractory Status Epilepticus and Reversible Cranial Nerve Reflex Loss: A Case Report.

The Recent article describes a case report of a 21-year-old woman with schizophrenia who ingested a massive amount of dextromethorphan, a common over-the-counter antitussive medication, during a suicide attempt. She took 20,280 mg of the drug

, which is significantly higher than the recommended dosage and other prescribed medications. As a result, she experienced severe adverse effects, including a generalized seizure and refractory status epilepticus, which is a life-threatening condition characterized by persistent seizures. Despite being discovered semiconscious and receiving immediate medical attention, the patient continued to experience seizures and required intensive treatment, including endotracheal intubation and administration of sedatives such as propofol and midazolam. The patient's condition eventually stabilized by day 4, and she became alert and responsive to commands. She was successfully extubated and discharged on day 9 without any long-term sequelae. The pharmacokinetic profiles of dextromethorphan and its active metabolite, dextrorphan, were monitored during the patient's hospital stay. The results suggested that dextromethorphan was responsible for the patient's symptoms, as its serum concentration was significantly higher than the therapeutic limits. In contrast, the serum concentration of dextrorphan remained within the therapeutic limits. This case highlights the importance of prompt and intensive supportive care in managing severe dextromethorphan toxicity, particularly when metabolism-altering factors such as CYP2D6 inhibition, genetic variability, or co-ingested medications are involved. The report also emphasizes the need for comprehensive descriptions of severe overdose cases, including pharmacokinetic data, to understand better the effects of dextromethorphan and its metabolites in such situations. By sharing this case report, healthcare professionals can gain valuable insights into the management of dextromethorphan overdose and improve patient outcomes.

Link: https://pubmed.ncbi.nlm.nih.gov/40077855/