Coma blisters, peripheral neuropathy, and amitriptyline overdose: a brief report.
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.
Maguiness
Sheilagh
S
University of Western Ontario, London, Ontario, Canada.
Guenther
Lyn
L
Shum
David
D
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*
D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline