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Hemoperfusion in a child with amitriptyline intoxication
Osman Dönmez1, Merih Cetinkaya, Rahmiye Canbek
1Department of Pediatric Nephrology, Faculty of Medicine, Uludag University, Bursa, Turkey. odonmez@uludag.edu.tr
Pediatric Nephrology (Berlin, Germany)
|November 2, 2004
Summary
Severe amitriptyline intoxication in a child was treated with hemoperfusion (HP). This hemoperfusion therapy proved effective in managing life-threatening symptoms and cardiac arrhythmias, suggesting it as a viable treatment option.
Area of Science:
- Toxicology
- Pediatric Critical Care
- Cardiology
Background:
- Tricyclic antidepressant (TCA) overdose is a significant cause of poisoning in children and adults.
- Amitriptyline, a common TCA, can cause severe toxicity, including seizures and cardiac arrhythmias.
Observation:
- A 17-month-old girl presented with severe amitriptyline intoxication (estimated 75 mg/kg).
- The patient exhibited coma, ventricular tachycardia, and multifocal clonic seizures.
- Standard treatments including activated charcoal, diazepam, lidocaine, and sodium bicarbonate were ineffective.
Findings:
- Hemoperfusion (HP) was initiated for 2 hours due to the patient's refractory status.
- During HP, the patient required six cardioversions for ventricular fibrillation.
- Clinical response to HP was very good, with no observed complications.
Implications:
- Hemoperfusion may be an effective and safe treatment for severe amitriptyline intoxication in children.
- This case highlights the potential of extracorporeal therapies in managing life-threatening TCA overdoses.
- Further research into hemoperfusion for pediatric poisoning is warranted.