A case of lethargy and cardiohepatic-renal dysfunction caused by accidental ingestion of an overdose of cetirizine in a young child

Published on Oct. 01, 2026Total Views: 707 times Total Downloads: 129 times Download Mobile

Author:  DENG Huaidong ¹ SHEN Jun ¹ YANG Yi ¹

Affiliation: 1.Central Pharmacy, Panzhihua Hospital of Integrated Traditional and Western Medicine, Panzhihua 617000, Sichuan Province, China

Keywords: Cetirizine Child Drug overdose Lethargy Liver dysfunction Renal dysfunction

DOI: 10.12173/j.issn.2097-4922.202605067

Reference: DENG Huaidong,SHEN Jun,YANG Yi. A case of lethargy and cardiohepatic-renal dysfunction caused by accidental ingestion of an overdose of cetirizine in a young child[J]. Frontiers in Pharmaceutical Sciences,2026,30(9):1620-1624. DOI:10.12173/j.issn.2097-4922.202605067[Article in Chinese]  Copied

Abstract
Full-text
References

Abstract

This paper reports a case of a 1-year-and-7-month-old toddler who developed lethargy, somnolence, and mild cardiac, hepatic, and renal dysfunction following an accidental massive overdose of cetirizine. The caregiver misinterpreted the prescribed dosage of "7 drops" as "7 mL" and administered 70 mg (10 mg/mL) of cetirizine on 2 consecutive evenings. The patient presented with significant central nervous system depression, accompanied by hepatic abnormalities (alanine aminotransferase 43 U/L, aspartate aminotransferase 80 U/L), glomerular hyperfiltration [estimated glomerular filtration rate 196 mL/(min·1.73 m²)], and mildly elevated myocardial enzyme levels (α-hydroxybutyrate dehydrogenase 234 U/L). After discontinuation of the suspected medication and symptomatic supportive treatment including fluid supplementation, the patient's mental status improved markedly within 5 days, and all hepatic and renal function and myocardial enzyme levels returned to normal ranges. This case highlights that cetirizine overdose can induce pronounced central nervous system depression and multi-organ dysfunction, with possible additive effects from concurrent viral infection. The drop formulation carries a risk of confusion between "drops" and "milliliters," underscoring the need for enhanced medication education in clinical practice. Early recognition, prompt withdrawal of the offending agent, and systematic monitoring of organ function alongside supportive therapy are essential in managing suspected overdose in pediatric patients.

Full-text

Please download the PDF version to read the full text: download

References

1. ChenCP, HansonE, WatsonJW, et al. P-glycoprotein limits the brain penetration of nonsedating but not sedating H₁-antagonists[J]. Drug Metab Dispos, 2003, 31(3): 312-318. DOI: 10.1124/DMD.31.3.312.

2. GuptaA, ChatelainP, MassinghamR, et al. Brain distribution of cetirizine enantiomers: comparison of three different tissue-to-plasma partition coefficients: K_p, K_p,u, and K_p,uu[J]. Drug Metab Dispos, 2006, 34(2): 318-323. DOI: 10.1124/DMD.105.007211.

3. ParisiGF, LeonardiS, CiprandiG, et al. Cetirizine use in childhood: an update of a friendly 30-year drug[J]. Clin Mol Allergy, 2020, 18(1): 2. DOI: 10.1186/s12948-020-00118-5.

4. SimonsFE, SimonsKJ. Histamine and H1-antihistamines: celebrating a century of progress[J]. J Allergy Clin Immunol, 2011, 128(6): 1151-1152. DOI: 10.1016/j.jaci.2011.09.006.

5. BrożekLJ, BousquetJ, AgacheI, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines——2016 revision[J]. J Allergy Clin Immunol, 2017, 140(4): 950-958. DOI: 10.1016/j.jaci.2017.03.050.

6. ZuberbierT, AbererW, AseroR, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria[J]. Allergy, 2018, 73(7): 1393-1414. DOI: 10.1111/all.13397.

7. 贾雪琳. 西替利嗪儿童用药安全性评价研究[D]. 辽宁大连: 大连医科大学, 2020. DOI: 10.26994/d.cnki.gdlyu.2020.000237.

8. RenkoA, CorteseT, KaragiannisP, et al. Unintentional cetirizine overdose causing anticholinergic syndrome[J]. Am J Emerg Med, 2022, 52: 270. e1-270. e3. DOI: 10.1016/J.AJEM.2021.08.062.

9. SharawatIK, DawmanL. Acute focal dystonia after a single dose of oral cetirizine in a 9-year-old boy[J]. Pediatr Emerg Care, 2017, 35(2): e30-e31. DOI: 10.1097/PEC.0000000000001062.

10. TyagiM, AhujaR, PatelV, et al. Fixed drug eruptions due to/caused by levocetirizine and cetirizine: an uncommon adverse cutaneous drug reaction to commonly used piperazine derivatives[J]. Indian Dermatol Online J, 2024, 15(4): 678-680. DOI: 10.4103/IDOJ.IDOJ_488_23.

11. VerduE, Blanc-BrissetI, MeyerG, et al. Second-generation antihistamines: a study of poisoning in children[J]. Clin Toxicol, 2020, 58(4): 275-283. DOI: 10.1080/15563650.2019.1634812.

12. CoskunA, YavasogluI, YasaMH, et al. Cetirizine-induced hepatotoxicity: case series and review of the literature[J]. Gastroenterol Rep, 2018, 6(3): 228-230.DOI: 10.1093/gastro/gow025.

13. 江美云. 盐酸西替利嗪引起不良反应[J]. 海峡药学, 2000, 12(4): 123.JiangMY. Adverse reactions induced by cetirizine hydrochloride[J]. Strait Pharmaceutical Journal, 2000, 12(4): 123. DOI: 10.3969/j.issn.1006-3765.2000.04.077.

14. 叶丽园, 傅寅, 毛晓华. 西替利嗪致肝损伤的文献分析[J]. 中国乡村医药, 2023, 30(18): 47-48.YeLY, FuY, MaoXH. Literature review on cetirizine-induced liver injury [J]. China Journal of Rural Medicine and Pharmacy, 2023, 30(18): 47-48. DOI: 10.19542/j.cnki.1006-5180.007540.

15. Vila-NadalG, Lleonart BellfillR, Marti GarridoJ, et al. Recurrent drug-induced liver injury with cetirizine and amoxicillin-clavulanate potassium[J]. J Investig Allergol Clin Immunol, 2019, 29(4): 321-322. DOI: 10.18176/jiaci.0397.

16. KatzJA, MahoneyDH, SteuberCP, et al. Human leukocyte alpha interferon-induced transient neurotoxicity in children[J]. Invest New Drugs, 1988, 6(2): 115-120. DOI: 10.1007/BF00195369.

17. LiuP, ZouR, ZhaoJ, et al.Changes in humoral immunity, myocardial damage, trace elements, and inflammatory factor levels in children with rotavirus enteritis[J]. Am J Transl Res, 2022, 14(1): 452-459. https://pmc.ncbi.nlm.nih.gov/articles/PMC8829652/.

18. 徐识. 血清LDH、α-HBDH在有机磷农药中毒伴心肌损伤患者中的检测分析及表达意义[J]. 现代诊断与治疗, 2021, 32(22): 3640-3641. [XuS. Detection and analysis of serum LDH and α-HBDH in patients with organophosphate pesticide poisoning complicated by myocardial injury and their expressive significance[J]. Modern Diagnosis and Treatment, 2021, 32(22):3640-3641. https://kns.cnki.net/kcms2/article/abstract?v=hH4Q DuxDhLS2-bF8MrVnR4XJMTsb-QA6uFR1tLx2yqrAXcdmsc01ltRg2s1sC_gfCcW8Y_nckK4xnK1lZxfRKnl8juDScHVY2Za0NIhJV2bDb6-qq68GSNE0NEoULySPHT3 1oYn1nry4ro_ES8_jLkHOx-9IV qsohvqqfEdvz68=&uniplatform=NZKPT.

19. 齐宇新, 刘姣, 何颖娜, 等. 乳腺癌术后蒽环类化疗药物致心脏损害的早期监测分析[J]. 中国药房, 2017, 28(17): 2356-2359.QiYX, LiuJ, HeYN, et al. Analysis of early monitoring for heart damage caused by anthracyclines chemotherapy drugs after breast cancer surgery[J]. China Pharmacy, 2017, 28(17): 2356-2359. DOI: 10.6039/j.issn.1001-0408.2017.17.14.

20. TashiroM, KatoM, MiyakeM, et al. Dose dependency of brainn histamine H₁ receptor occupancy following oral administration of cetirizine hydrochloride measured using PET with [¹¹C] doxepin[J]. Hum Psychopharmacol, 2009, 24(7): 540-548. DOI: 10.1002/hup.1051.

21. DuQ, ZhouY. Placebo-controlled assessment of somnolence effect of cetirizine: a Meta-analysis[J]. Int Forum Allergy Rhinol, 2016, 6(8): 871-879. DOI: 10.1002/alr.21746.

22. 合理用药国际网络(INRUD)中国中心组临床安全用药组, 中国药理学会药源性疾病学专业委员会, 中国药学会医院药学专业委员会,药物不良反应杂志社. 中国用药错误管理专家共识[J]. 药物不良反应杂志, 2014, 16(6): 321-326.International Network for Rational Drug Use (INRUD) China Central Group Clinical Safe Drug Use Team, Chinese Pharmacological Society Professional Committee on Drug-Induced Diseases; Chinese Pharmaceutical Association Professional Committee on Hospital Pharmacy, Journal of Adverse Drug Reactions. China expert consensus on medication error management[J]. Adverse Drug Reactions Journal, 2014, 16(6): 321-326 DOI: 10.3760/cma.j.issn.1008-5734.2014.06.001.