title: Use of dosage as a triage guideline for unintentional cyclic antidepressant (UCA) ingestions in children.
abstract: Triage guidelines for unintentional cyclic antidepressant (UCA) ingestions vary widely, with limited supportive evidence. All records of UCA ingestion reported to 4 certified regional poison centers were evaluated for the years 1998 through 2000. Inclusion criteria included age </=6 years patients with a known outcome and known ingested dose by history. Exclusion criterion was polydrug ingestion. Two hundred forty-six cases were evaluated. The mean age was 2.4 years (standard deviation, +/-1.2 y). One hundred thirty-six patients (55%) were managed in a hospital. One hundred ten patients were managed at home with observation and telephone follow up. Symptoms reported were drowsiness (n = 59), tachycardia (n = 4), agitation (n = 2), coma (n = 2), respiratory depression (n = 1), and ataxia (n = 1). Medical outcome was reported as no effect (n = 185; 75%), minor effect (n = 57; 23%), moderate effect (n = 2; 1%); and major effect (n = 2; 1%). Mean dosage of patients with and without symptoms was 6.3 mg/kg (+/- 9.3) and 2.9 mg/kg (+/- 3.1), respectively. Forty-three of 57 patients (75%) with minor symptoms reported a dosage of <5 mg/kg. All patients with a moderate or major outcome (n = 4) reported a dosage of >5 mg/kg. The majority of UCA ingestions produced limited or no symptomatology. In this series, all children with ingestions of <5 mg/kg developed no or minor effects. Home monitoring might be appropriate in such cases.
authors.affiliation: Kentucky Regional Poison Center, Louisville, Kentucky 40232, USA. henry.spiller@nortonhealthcare.org
authors.forename: Henry A
authors.initials: HA
authors.lastname: Spiller
authors.forename: S David
authors.initials: SD
authors.lastname: Baker
authors.forename: Edward P
authors.initials: EP
authors.lastname: Krenzelok
authors.forename: Letizia
authors.initials: L
authors.lastname: Cutino
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000628:therapy; D006801:Humans; D007223:Infant; D011041:Poisoning / Q000628:therapy*; D017410:Practice Guidelines as Topic; D014218:Triage / Q000379:methods*
chemical_list: D000929:Antidepressive Agents, Tricyclic