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Published on: April 5, 2011
Clinical, electrocardiographic, and laboratory findings in children with amitriptyline intoxication
Haşim Olgun1, Zuhal Keskin Yildirim, Mehmet Karacan
1Division of Pediatric Cardiology, Ataturk University, Faculty of Medicine, Erzurum, Turkey. drholgun@hotmail.com
Insights
Amitriptyline poisoning in children can cause severe toxicity. Electrocardiogram (ECG) changes like QRS duration can predict coma, while R wave absence in aVR may predict seizures.
Area of Science:
- Pediatric Toxicology
- Cardiology
- Emergency Medicine
Background:
- Limited data exists on amitriptyline poisoning in children.
- Amitriptyline is a common tricyclic antidepressant.
Purpose of the Study:
- To analyze clinical and electrocardiogram (ECG) findings in pediatric amitriptyline poisoning.
- To correlate ECG changes with clinical status and predict outcomes.
Main Methods:
- Retrospective review of 52 children with amitriptyline poisoning.
- Analysis of clinical, laboratory, and ECG data.
- Comparison between two age groups: ≤6 years and >6 years.
Main Results:
- Lethargy, sinus tachycardia, and coma were frequent findings.
- ECG abnormalities included QTc prolongation and widened QRS duration.
- A QRS duration ≥100 ms predicted coma (100% positive predictive value).
- An R wave in aVR <3 mm predicted absence of seizures (100% negative predictive value).
Conclusions:
- Amitriptyline poisoning can lead to severe toxicity in children.
- ECG findings, particularly QRS duration and R wave in aVR, can predict clinical outcomes like coma and seizures.
- Age did not significantly influence the frequency of clinical, laboratory, or ECG findings.
Background:
Amitriptyline is one of the major tricyclic antidepressants, and the data on amitriptyline poisoning in children are limited.
Objectives:
To present our experiences with amitriptyline poisoning in children, particularly with regard to its effects on electrocardiogram (ECG) and relation with clinical status.
Methods:
Clinical, laboratory, and electrocardiographic findings in 52 children admitted with amitriptyline poisoning were reviewed. Patients were divided into 2 groups according to age, as 6 years or younger (group A) and older than 6 years (group B).
Results:
Mean age was 4.6 +/- 3.0 years. Thirty-one patients were male, and 41 were 6 years or younger. Ingested amitriptyline dose was known in 23 patients (range, 2.3 mg/kg-27 mg/kg). The most frequent findings were lethargy (76.9%), sinus tachycardia (57.7%), and coma (48.1%). Four patients had a history of convulsion. The most common laboratory abnormalities were hyponatremia (26.9%) and leukocytosis (25%). Elevated transaminase levels were observed in 4 patients. In ECG, 11 (22.4%) patients had QTc prolongation and in 4 (8.2%) of them, it was significant. In 4 patients (8.2%), the QRS duration was 100 ms or longer and in 15 patients, the R wave in aVR was 3 mm or longer. The frequencies of clinical, laboratory, and electrocardiographic findings were similar between the 2 age groups (P > 0.05). No clinically apparent arrhythmias were observed. The positive predictive value of a widened QRS was 100% in terms of coma. None of the patients with an R wave in aVR of less than 3 mm developed convulsion; thus, the negative predictive value of an R wave in aVR of 3 mm or longer was 100% in terms of convulsion.
Conclusions:
Amitriptyline poisoning may result in severe toxicity. Frequencies of clinical, laboratory, and ECG findings were similar in the 2 age groups. Amitriptyline overdose results in some ECG changes that can possibly help to predict the results of poisoning. Absence of an R wave in aVR of 3 mm or longer predicts seizures with a high negative predictive value, and a QRS duration of 100 or longer ms predicts coma with a high positive predictive value.
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