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Related Concept Videos

Toxidromes: Clinical Features01:30

Toxidromes: Clinical Features

Toxidromes are specific patterns of symptoms resulting from toxic substance exposure. They help in the identification and treatment of poisoning. The symptoms of each toxidrome group indicate poisoning by a certain class of chemicals or drugs.1. Sympathomimetic: Stimulates the sympathetic nervous system. Symptoms include agitation, increased heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature, and pupil size. Drugs like cocaine and amphetamines, along with tremors and...
Pharmaceutical Poisoning: Treatment Strategies01:26

Pharmaceutical Poisoning: Treatment Strategies

Treatment strategies for poisoning are a critical aspect of emergency medicine, focusing on preventing the absorption of toxins and enhancing their elimination. When a poisoning incident occurs, the first response is to halt exposure and decontaminate the patient, particularly through gastrointestinal (GI) methods if the poison was ingested.Gastrointestinal Decontamination Techniques:Activated charcoal is the cornerstone of GI decontamination. It works through adsorption, binding the toxin to...
Anticholinesterase Agents: Poisoning and Treatment01:26

Anticholinesterase Agents: Poisoning and Treatment

Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.     
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is slower than the...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Drug Toxicity: Overview01:00

Drug Toxicity: Overview

Drug toxicity quantifies the harm a compound causes to an organism, varying by dose and potentially impacting whole systems or specific organs like the liver. Toxic reactions may arise from venomous insect or spider bites, with effects ranging from mild symptoms to severe outcomes such as brain damage or death. Common forms of acute poisoning include ethanol intoxication and overdose of pain or fever medications, with substances like GHB and heroin being particularly lethal at doses close to...
Drug Accumulation During Multiple Dosing: Intermittent IV Infusions01:24

Drug Accumulation During Multiple Dosing: Intermittent IV Infusions

Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...

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Updated: May 23, 2026

Adaptation of Microelectrode Array Technology for the Study of Anesthesia-induced Neurotoxicity in the Intact Piglet Brain
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Chronic amitriptyline overdose in a child.

Alan Clement1, Jeremiah J Raney, Gary S Wasserman

  • 1Department of Graduate Medical Education, Division of Clinical Pharmacology and Medical Toxicology, University of Missouri School of Medicine, Kansas City, MO, USA.

Clinical Toxicology (Philadelphia, Pa.)
|April 3, 2012
PubMed
Summary
This summary is machine-generated.

A child experienced severe toxicity from a chronic amitriptyline overdose, including seizures and cardiac issues. Prompt treatment with sodium bicarbonate led to a full recovery, highlighting the importance of accurate pediatric dosing.

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Area of Science:

  • Pediatric Toxicology
  • Clinical Pharmacology
  • Child Neurology

Background:

  • Amitriptyline (tricyclic antidepressant) toxicity is well-documented in acute overdose cases.
  • Limited literature exists on the effects of chronic amitriptyline overdose in children.

Observation:

  • A 6-year-old girl received a 10-fold higher nightly dose of amitriptyline (300 mg vs. 30 mg) for over a month.
  • She developed altered mental status, reading difficulties, status epilepticus, and significant cardiac conduction abnormalities.

Findings:

  • Her amitriptyline/nortriptyline level was critically high at 1676 ng/mL.
  • Treatment with sodium bicarbonate rapidly resolved both neurological and cardiac symptoms.
  • The child recovered fully without long-term sequelae.

Implications:

  • This case underscores the potential dangers of chronic amitriptyline overdose in pediatric patients.
  • It highlights the effectiveness of sodium bicarbonate in managing severe tricyclic antidepressant toxicity.
  • Pharmacogenomic factors may play a role in individual responses to amitriptyline toxicity.