title: Coma blisters, peripheral neuropathy, and amitriptyline overdose: a brief report.
abstract: BACKGROUND
  Coma blisters are most commonly associated with barbiturate and benzodiazepine overdose; however, they have also been described in association with many other substances, including amitriptyline.
  
  
  OBJECTIVE
  To review the literature on the clinical manifestations of coma blisters in the setting of amitriptyline overdose.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  Coma blisters in association with amitriptyline overdose have rarely been documented in the literature. Of the few reported cases, peripheral neuropathy has been present two (including our case report) out of four times.
  
  
  CONCLUSIONS
  Amitriptyline is known to impair endothelial cell tight junction integrity. Thus, individuals with amitriptyline overdose may be predisposed to microvascular damage during the compression imposed from a comatose state. This may help to explain the tendency for patients to present with the interesting triad of coma, blisters, and neuropathy.
authors.affiliation: University of Western Ontario, London, Ontario, Canada.
authors.forename: Sheilagh
authors.initials: S
authors.lastname: Maguiness
authors.forename: Lyn
authors.initials: L
authors.lastname: Guenther
authors.forename: David
authors.initials: D
authors.lastname: Shum
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D001768:Blister / Q000139:chemically induced* / Q000473:pathology; D003128:Coma / Q000139:chemically induced* / Q000473:pathology; D062787:Drug Overdose; D005260:Female; D006801:Humans; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline