13 March 2025
: Case report 
Dextromethorphan Overdose with Refractory Status Epilepticus and Reversible Cranial Nerve Reflex Loss: A Case Report
Unusual clinical course
Akifumi Okamoto
ABDEF 1, Naoki Yonezawa ABDEF 2*, Kazuhiro Yoshizawa ABDF 2, Reiki Kumashiro DE 2, Shinya Suzuki D 1,3
DOI: 10.12659/AJCR.946447
Am J Case Rep 2025; 26:e946447
Table 1. Adult survival cases of dextromethorphan overdose in which blood dextromethorphan and dextrorphan concentrations were specifically documented.
| Author, year [ref. no.] | Age (years) | Gender | Ingested dextromethorphan amount | Concomitant drugs | Serum dextrorphan concentration (mg/L) | Serum dextromethorphan concentration (mg/L) | Clinical symptoms |
|---|---|---|---|---|---|---|---|
| Kuwana et al, 2024 []4 | Older adolescent | Male | 4,500 mg | Flunitrazepam | 3.7 | N/A | Altered mental status, tachycardia, mydriasis, shock, hyperthermia, refractory status epilepticus, muscle rigidity, flushed skin, and serotonin syndrome |
| Monte et al, 2010 []5 | 19 | Male | Up to 1,440 mg | Chlorphenamine | 0.25 | N/A | Agitation, delirium, hypertension, tachycardia, hyperthermia, hyperreflexia, mydriasis, ocular clonus, and inducible ankle clonus |
| Schwartz et al, 2008 []6 | 20 | Male | Unknown | Escitalopram, chlorpheniramine, benztropine, aripiprazole | 0.95 | N/A | Confusion, tremor, hyperthermia, hypertension, hyperthermia, ankle clonus, muscle rigidity, hyperreflexia, mydriasis, and diaphoresis |
| Ganetsky et al, 2007 []7 | 18 | Male | Up to 480 mg | Chlorpheniramine | 0.93 | N/A | Tachycardia, agitation, diaphoresis, mydriasis, ocular clonus, muscle rigidity, tremor, and hyperreflexia |
| Present case | 21 | Female | Up to 20,280 mg | Triazolam, alprazolam, risperidone, duloxetine, brotizolam | 5.8 | 0.65 | Altered mental status, tachycardia, mydriasis, shock, hyperthermia, refractory status epilepticus, reversible suppression of cranial nerve reflexes, and flushed skin |
| N/A – not applicable. | |||||||