JD, a 27-year-old woman with a history of depression and insomnia, was admitted to the emergency room unconscious after taking excessive doses of diphenhydramine, an allergy medication that also induces drowsiness. She had been experiencing severe insomnia, which led her to escalate the dose of diphenhydramine to four to five times the recommended amount, resulting in acute megacolon and subsequent septic shock due to colonic perforation. Despite the severity of her condition, JD was treated successfully through surgery and intensive care, eventually recovering consciousness and returning home. The case highlights the dangers of self-medication and drug interactions.
Here are the key facts extracted from the text:
1. JD, a 27-year-old woman, was admitted to the emergency room unconscious.
2. She had been awake for 48 hours before being brought to the hospital.
3. JD had been experiencing insomnia for seven months.
4. She was an attorney, and her job performance began to suffer due to her sleep issues.
5. JD started taking supplements to help her sleep, but they didn't work consistently.
6. She then consulted a neurologist and tried cognitive behavioral therapy, but found limited success.
7. JD began taking over-the-counter medication, specifically diphenhydramine, to help her sleep.
8. She took four to five times the recommended dose each night to sleep for a few hours.
9. JD experienced stomach pain, constipation, and other side effects from taking diphenhydramine.
10. She went nine days without a bowel movement or proper sleep.
11. JD's boyfriend found her unresponsive and called 911, leading to her hospitalization.
12. At the hospital, JD was diagnosed with acute megacolon, a condition where the colon becomes enlarged.
13. An abdominal CT scan revealed no mechanical obstructions in her colon, but her colon was dilated.
14. JD's condition was caused by the high doses of diphenhydramine, which slowed down her digestive system.
15. The medication blocked the chemicals that transmit signals in the nerves, leading to a slowdown of the digestive system.
16. JD's colon became so slow that it led to a buildup of pressure, causing her colon to dilate.
17. The tension in the wall of the dilated segment of her colon was elevated, leading to a reduction in blood flow.
18. JD's colon became necrotic, and the tissue began to die.
19. The necrotic tissue lost its muscular integrity, leading to a perforation of the colon.
20. JD's intestinal contents spilled into her peritoneal cavity, causing bacteria to enter her bloodstream.
21. She developed septic shock, a life-threatening condition that requires immediate treatment.
22. JD was admitted to the intensive care unit and received antibiotics and early goal-directed resuscitation.
23. Her condition stabilized over the following days, and she regained consciousness.
24. JD underwent surgery to remove her colon, and her gut was surgically anastomosed.
25. She was eventually discharged from the hospital and recovered at home.