Dextromethorphan Toxicity

1. See Also
   1. Dextromethorphan
2. Background
   1. Dextromethorphan Abuse is increasing in United States (especially among teens)
   2. Coricidin ("skittles") is a common source of abuse agent
3. Mechanism
   1. Dextromethorphan has NMDA activity and serotonergic activity
4. Signs
   1. General
      1. Altered Level of Consciousness
      2. Does not typically cause respiratory depression
   2. Dose-Dependent Effects
      1. Low dose: Ataxia on ambulation ("robo walk")
      2. High dose: Auditory and visual hallucinations
   3. Combination product abuse
      1. Products containing Diphenhydramine might present with Anticholinergic Toxicity
5. Labs
   1. Hyperchloremia and normal Anion Gap
      1. Limited to Dextromethorphan preparations containing hydrobromide salt
   2. Acetaminophen Level
      1. Elevated if combination product was abused
6. Management
   1. Supportive care
   2. Naloxone is unlikely to have much effect unless there is respiratory depression
7. Course
   1. Short acting agents: 6 hours
   2. Long acting agents (Delsym): 12 hours
8. Complications
   1. Serotonin Syndrome (when combined with other serotonergic agents)
9. References
   1. Nordt and Swadron in Majoewsky (2012) EM: RAP 12(5): 3