Abstract
Altered mental status and fever in a teenager can be a challenging diagnostic dilemma and thus requires a detailed history and a broad differential diagnosis and workup. A teenager presented with altered mental status and fever was found incidentally to have a pituitary hemorrhage (pituitary apoplexy) but ultimately diagnosed with doxylamine intoxication. Doxylamine, an antihistamine commonly included in sleep aids, toxicity may present with fever and altered mental status and may result in a false positive methadone result on urine toxicology studies due to interference with immunoassay-based drug kits. Pituitary apoplexy is a rare complication of pituitary tumors, usually presenting with headache, visual impairment, and corticotropic abnormalities but not typically associated with altered mental status or impaired consciousness. Although it has the potential for serious sequelae, presentations in pediatric patients have been more subacute.
Similar content being viewed by others
Data Availability
Not applicable.
References
Forti RJ, Avner JR. Altered mental status. American Academy of Pediatrics Textbook of Pediatric Care, 2nd Edition, chapter 349.
Claire B, et al. Pituitary apoplexy. Endocr Rev. 2015;36(6):622–45. https://doi.org/10.1210/er.2015-1042.
Jankowski PP, et al. Pituitary tumor apoplexy in adolescents. World Neurosurg. 2015;83(4):644–51. https://doi.org/10.1016/j.wneu.2014.12.026.
Syed H, Som S, Khan N, Faltas W. Doxylamine toxicity: seizure, rhabdomyolysis and false positive urine drug screen for methadone. Case Rep. 2009;2009:bcr0920080879. https://doi.org/10.1136/bcr.09.2008.0879.
Balan G, et al. Doxylamine pharmacokinetics following single dose oral administration in children ages 2–17 years. J Clin Pharmacol. 2013;53(11):1177–85. https://doi.org/10.1002/jcph.137.
Acknowledgements
Thank you to the Pediatric Intensive Care Unit staff and Pediatric Endocrinology, Neurosurgery, Psychiatry, Neurology, Social Work teams at the LAC+USC Medical Center in the exemplary multidisciplinary care of this child.
Author information
Authors and Affiliations
Contributions
Dr. Bhattacharjee, Dr. Cervantes, Dr. Cao, and Dr. Im all contributed to the literature review and manuscript preparation of the case report. Dr. Im was responsible for the final review and editing of the manuscript.
Corresponding author
Ethics declarations
Ethics Approval
This article does not contain any studies with human participants or animals performed by any of the authors. All authors have disclosed no financial relationships relevant to this article. This article does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Informed Consent
Received from patient and guardian.
Consent to Participate
Consent obtained for case report publication.
Consent for Publication
Consent obtained for case report publication.
Competing Interests/Conflict of Interest
The authors declare no competing interests.
Code Availability
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Medicine
Rights and permissions
About this article
Cite this article
Bhattacharjee, S., Cervantes, L., Cao, C. et al. Doxylamine Overdose in Teenager with Incidental Pituitary Apoplexy: Case Report. SN Compr. Clin. Med. 3, 694–697 (2021). https://doi.org/10.1007/s42399-021-00763-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s42399-021-00763-0