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Efficacy of long duration resuscitation and magnesium sulphate treatment in amitriptyline poisoning

A Citak1, D Demirkol Soysal, R Uçsel

  • 1Department of Paediatric Emergency, Institute of Child Health, University of Istanbul, Turkey.

European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine
|May 7, 2002
PubMed

Insights

Tricyclic antidepressant overdose in children can be fatal. Extended cardiopulmonary resuscitation and magnesium sulfate treatment proved effective in a severe amitriptyline poisoning case.

Area of Science:

  • Emergency Medicine
  • Pediatric Toxicology
  • Cardiology

Background:

  • Cyclic antidepressants, like amitriptyline, are common in pediatric overdose cases.
  • Overdose can cause severe myocardial depression and life-threatening ventricular arrhythmias.
  • Prompt recognition and management are critical for survival.

Observation:

  • A 23-month-old child ingested a significant dose of amitriptyline (36 mg/kg).
  • The child experienced cardiac and respiratory arrest, requiring 70 minutes of cardiopulmonary resuscitation (CPR).
  • Ventricular tachycardia refractory to standard treatments (lidocaine, bicarbonate, cardioversion) developed.

Findings:

  • Magnesium sulfate administration successfully normalized the cardiac rhythm.
  • The patient experienced no adverse effects following magnesium sulfate treatment.
  • Prolonged resuscitation efforts (at least 1 hour) are recommended for cyclic antidepressant-induced cardiopulmonary arrest.

Implications:

  • Magnesium sulfate is a potentially life-saving treatment for refractory ventricular arrhythmias in cyclic antidepressant overdose.
  • Extended CPR duration should be considered in pediatric cyclic antidepressant intoxication.
  • This case highlights the critical need for advanced toxicological interventions in severe pediatric poisonings.

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