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Severe childhood amitriptyline intoxication and plasmapheresis: a case report
Mehmet Karacı1, Mustafa Özçetin, Günter Dilsiz
1Department of Pediatrics Bülent Ecevit University, Faculty of Medicine, Zonguldak, Turkey. mkaraci@gmail.com.
The Turkish Journal of Pediatrics
|March 1, 2014
Summary
Tricyclic antidepressant intoxication, like amitriptyline, is life-threatening. Plasmapheresis, a blood cleansing procedure, can be a life-saving treatment for severe cases when traditional methods fail.
Area of Science:
- Emergency Medicine
- Clinical Toxicology
- Critical Care
Background:
- Tricyclic antidepressant (TCA) intoxication is a common and severe emergency. There is no specific antidote for TCAs. The American Society for Apheresis (ASFA) suggests plasmapheresis for severe poisonings unresponsive to standard treatments.
- Amitriptyline, a frequently used TCA, poses significant risks in overdose scenarios.
Observation:
- A 15-year-old female presented with severe amitriptyline intoxication after a suicide attempt. She exhibited a coma (Glasgow Coma Scale score: 5), respiratory arrest, and pathological reflexes.
- Given the lethal dose ingestion and critical condition, plasmapheresis was initiated.
Findings:
- The patient successfully underwent plasmapheresis. She was discharged on the fifth day of hospitalization, indicating a positive outcome from the intervention.
- The high plasma protein binding of amitriptyline supports the consideration of plasma exchange therapy.
Implications:
- Plasma exchange therapy is a viable, life-saving option for managing severe amitriptyline intoxication. This case highlights the importance of considering extracorporeal treatments in critical toxicology.
- Further research into the efficacy and optimal protocols for plasmapheresis in TCA overdose is warranted.
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