19 yo with dextromethorphan ingestion

Attending: Dr Kaide
Residents: Rosevear, Holland, Patetl, Gathof, Chan, Cummins, and others.
Others: Erin

Topic: Dextromethorphan Ingestion

19 y.o. female with depression who presents s/p ingestion of 20 pills of tussin cough liquid gels. She says that she did not intend to harm herself, she was using them to “escape” her feelings. She denies any hallucinations. She took the pills at ~1700-1800 and vomited 3 times at ~2100. Her mother and father brought her to the ED due to the vomiting. She says her world is still “spinning”. Denies any hallucinations. The patient does say she researched how to do this on the Internet so she wouldn’t get hurt. No other symptoms. Parents brought the bottle with her. Only active ingredient is Dextromethorphan.

PE: Marked horizontal and vertical nystagmus. No other findings.

Labs: Urine preg negative, Chem 7 unremarkable

Teaching points:

1. Dextromethorphan – The Chemical Breakdown
– Peak plasma concentrations in 2.5 hours
– Glutamate and NMDA antagonist, and blocks the dopamine reuptake site. (think ketamine/PCP)
– Metabolized by the liver
– Half Life of 2-4 hours normally but in impaired individuals can be much much longer.

2. Ingestion Drill
– Had a uterus, Bhcg, Chem 7 was requested by poison control who reported her symptoms should begin resolving after ~6
– Aspirin, Tylenol levels negative.
– Test for things that 1) have ill affects and 2) you can do something about.

3. How to learn to get high – Know thy enemy
– Google search “get high cheap” first link, 3rd response.
– Google search “get high cough syrup”. Multiple enteries with knowldge on this subject. Many indicating to look for and “DXM” source with only DXM as active ingredient.

-Its easy to get high and how to learn to do so cheaply.
-Watch out for the other ingredients. Dextromethorphan by itself is relatively safe however other additives to cough medications such as Tylenol are much more lethal.

Thanks to Dr. Kaide for the help with this one.