Amitriptyline poisoning in a 2-year old.
We describe a case of a 2-year-old boy who ingested 35 mg.kg(-1) of amitriptyline. He developed central nervous system toxicity, as demonstrated by coma and seizures and cardiac toxicity (cardiac arrest) within 1 h of ingestion. The cardiac toxicity was refractory to standard therapy. His cardiac rhythm alternated between ventricular tachycardia and pulseless ventricular tachycardia/ventricular fibrillation for a period of 17 h. Following prolonged cardiopulmonary resuscitation and aggressive supportive management, the patient recovered both cardiovascularly and neurologically. An echocardiogram and MRI brain were subsequently performed and were normal. The patient was discharged 2 weeks later with normal cognitive, behavioral and motor function. We discuss the benefit of prolonged and effective cardiopulmonary resuscitation in the management of this potentially fatal poisoning.
Deegan
Catherine
C
Department of Anaesthesia and Intensive Care Medicine, Children's University Hospital, Temple Street, Dublin 1, Ireland.
O'Brien
Kay
K
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000639:Amitriptyline / Q000506:poisoning*; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D000927:Anticonvulsants / Q000008:administration & dosage; D001784:Blood Gas Analysis / Q000379:methods; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002675:Child, Preschool; D003128:Coma / Q000139:chemically induced; D062787:Drug Overdose / Q000188:drug therapy; D006323:Heart Arrest / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D008278:Magnesium Sulfate / Q000008:administration & dosage; D008297:Male; D012640:Seizures / Q000139:chemically induced / Q000188:drug therapy; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
D000318:Adrenergic beta-Agonists; D018712:Analgesics, Non-Narcotic; D000927:Anticonvulsants; D006993:Hypnotics and Sedatives; D014665:Vasodilator Agents; D000639:Amitriptyline; D008278:Magnesium Sulfate; D017693:Sodium Bicarbonate