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Diphenhydramine HCl overdosage may vary from CNS depression to CNS stimulation. Stimulation is particularly likely in children. Atropine-like signs and symptoms such as dry mouth, fixed and dilated pupils, flushing, and GI symptoms may also occur. Additional symptoms may include mydriasis, fever, flushing, agitation, tremor, dystonic reactions, hallucinations, and electrocardiogram changes. Large overdose may cause rhabdomyolysis, convulsions, delirium, toxic psychosis, arrhythmias, coma, and cardiovascular collapse.
Treatment should be supportive and directed towards specific symptoms. Administration of activated charcoal should be considered. Empty stomach by aspiration and lavage. Emetics may be tried if the patient is alert. Convulsions and marked CNS stimulation should be treated with parenteral diazepam.
