title: Chronic amitriptyline overdose in a child.
abstract: Amitriptyline, a tricyclic antidepressant, has a well-described toxicity profile, and acute ingestions are common in the pediatric toxicology world. However, little can be found in the literature regarding chronic overdose. We describe a case of a 6-year-old girl who was prescribed amitriptyline 30 mg nightly for sleep problems, but was mistakenly given 300 mg (15 mg/kg) nightly for over a month. She was noted to have mental status changes and difficulty reading several days after starting the medication. She presented to the local children's hospital in status epilepticus with significant cardiac conduction abnormalities on ECG. Her total amitriptyline/nortriptyline level was found to be 1676 ng/mL (normal therapeutic level 50-300 ng/mL). She was treated for several days with sodium bicarbonate. Within 24 h, her neurologic status improved and had returned to baseline within several days. Her ECG normalized, and she was discharged home, without apparent sequelae. A brief discussion of possible protective mechanisms (including pharmacogenomic) is presented.
authors.affiliation: Department of Graduate Medical Education, Division of Clinical Pharmacology and Medical Toxicology, University of Missouri School of Medicine, Kansas City, MO, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Clement
authors.forename: Jeremiah J
authors.initials: JJ
authors.lastname: Raney
authors.forename: Gary S
authors.initials: GS
authors.lastname: Wasserman
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Lowry
mesh_terms: D000639:Amitriptyline / Q000493:pharmacokinetics / Q000506:poisoning* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000493:pharmacokinetics / Q000506:poisoning* / Q000627:therapeutic use; D002648:Child; D062787:Drug Overdose; D004562:Electrocardiography; D005260:Female; D006801:Humans; D009661:Nortriptyline / Q000493:pharmacokinetics; D012893:Sleep Wake Disorders / Q000139:chemically induced / Q000188:drug therapy; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D013226:Status Epilepticus / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline; D017693:Sodium Bicarbonate; D009661:Nortriptyline