1. R1. 박정숙

2. Introduction
Doxylamine succcinate is an antihistamine commonly used as an over-the counter drug to relieve insomnia and has anticholinergic effect
Drug is relatively safe, but is known to induce rhabdomyolysis
Treatment of rhabdomyolysis induced by doxylamine over-dose is by aggressive hydration and urine alkalization

3. Objective
To compare the effectiveness and side effects of lactate Ringer’s solution(LR) and 0.9% saline(NS) is the treatment of rhabdomyolysis induced by doxylamine intoxication

4. Methods Randomised mono-blind study
2-tertiary teaching hospital in seoul, Korea
January 2005 to May 2006
Exclusion
ingested other additional drugs
History of renal, muscular, central nervous system, ischemic heart disease
Defined rhabdomyolysis
serum CK>1000IU/L
20%mannitol or fureosemide IV:Urine Output<300ml/h

5. Methods

6. Result 97patient enroll 8 patient excluded
N=28(31%) patients develop rhabdomyolysis
LR group (n=15) vs NS group ( n=13)

7. Result
The median time to diagnosis of rhabdomyolysis was 15h(14~17) from ingestion
The median CK level when diagnosis of rhabdomyolysis
NS group ; 3282(1189~7430)
LR group ;4497(2288~9390)

9. Result After 12h aggressive hydration (400ml/h) Urine alkalisation
Urine and serum pH of the LR group were significantly higher than those of the NS group
NS group had significantly higher serum Na+ and Cl-
No difference in the serum K+ level
The median time interval to CK normalisation is statically not different
Urine alkalisation
LR group: 2 (15) patient received sodium bicarbonate 40~60mEq
NS group: 13(13) patient receive sodium bicarbonate 140mEq(100~700)

10. Conclusion
There was no difference in time interval to normalisation of serum CK level after aggressive hydration treatment
Unlike NS, patients who received LR need little supplemental sodium bicarbonate and did not develop metabolic acidosis
Hence, LR could be used safely in the hydration therapy of doxylamine-indeced rhabodomyolysis than NS