Benadryl in pt's with compromised liver function

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Transported a pt who was diagnosed w/ liver cancer the other day. Liver was palpable and skin/eyes were fully jaundiced. Prior to transferring care to me, the:glare: pt was given 1mg hydromorphone IV for pain. En route pt developed pretty bad itching to the point where she looked completely miserable. I decided to give her 50mg benadryl IV for it.

She stated it felt a little better but she was still itching pretty bad. Looking back I guess it makes sense why it didn't help much but did I cause any harm? This is pretty much the first time I've given a drug as a medic. On the job less than a full month. I know my standing orders dont list liver compromise as a relative contraindication for administration of benadryl but I was just wondering.
 
It's fine.

So, why were you worried about giving her Benadryl?

Why do you think she was itching?
 
Also, look up the metabolism of Benadryl.

That article was more dealing with chronic liver disease. May not necessarily be similar to what this lady had/has. If she has long standing liver disease (alcohol, NASH, hepatitis, etc...) then that's one thing, but right now we only know she has some sort of hepatobiliary cancer.

If she was obviously jaundiced then that points to some sort of biliary obstruction from her cancer.... Either a hepatic, biliary, or pancreatic cancer if we're just talking about a primary cancer.

So she could have relatively normal liver synthetic function (no cirrhosis) but have obstructive jaundice.
 
FLdoc2011 said:
Also, look up the metabolism of Benadryl.

That article was more dealing with chronic liver disease. May not necessarily be similar to what this lady had/has. If she has long standing liver disease (alcohol, NASH, hepatitis, etc...) then that's one thing, but right now we only know she has some sort of hepatobiliary cancer.

If she was obviously jaundiced then that points to some sort of biliary obstruction from her cancer.... Either a hepatic, biliary, or pancreatic cancer if we're just talking about a primary cancer.

So she could have relatively normal liver synthetic function (no cirrhosis) but have obstructive jaundice.
Click to expand...

True.
 
I'll let him look into the metabolism, but personally I've never thought twice about giving a bad liver disease patient an occasional dose of Benadryl.
 
I agree with the decision to try some benedryl but the itching was likely not histamine related.
Any other history related to or suggesting liver issues? Thrush?
 
Jaundiced patients often itch, sometimes severely. Likely had little or nothing to do with the hydromorphone.
 
Benadryl can ease itching by acting on the CNS also.
 
blindsideflank said:
the anticholinergic effect? specifically antimuscarinic?
Click to expand...
You know, I'm not sure. But I remember talking with our doc about it and he said the antihistamine effect was one part of the relief action, the other was CNS, maybe sedation.
 
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