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Amitriptyline Intoxication in Children: Twenty Years' Experience in a Tertiary Care Center in Turkey

Tülay Kamasak1, Şebnem Kader2, Mehmet Mutlu2

  • 1From the Pediatric Neurology.

Pediatric Emergency Care
|March 10, 2020
PubMed

Insights

Amitriptyline overdose in children, particularly those aged 1-4 years, frequently causes lethargy and sinus tachycardia. High-dose tricyclic antidepressant ingestion is a significant cause of pediatric mortality and morbidity.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Toxicology
  • Pharmacology

Background:

  • Amitriptyline ingestion is a significant cause of poisoning morbidity and mortality globally, with limited data on pediatric cases.
  • Tricyclic antidepressant (TCA) overdose presents unique challenges in children.
  • Understanding pediatric-specific intoxication patterns is crucial for effective management.

Purpose of the Study:

  • To investigate the clinical and laboratory findings of amitriptyline intoxication in pediatric patients.
  • To analyze intoxication patterns based on age groups and ingested dosages.
  • To identify key indicators of severe outcomes in pediatric amitriptyline poisoning.

Main Methods:

  • Retrospective analysis of 192 pediatric patients with amitriptyline intoxication (1997-2017).
  • Patients categorized by amitriptyline dose and age.
  • Comprehensive laboratory tests (CBC, glucose, electrolytes, LFTs, coagulation, blood gas) and ECG performed.
  • Chest radiography and EEG utilized for specific symptom evaluation.

Main Results:

  • Amitriptyline intoxication most common in children aged 1-4 years.
  • Lethargy, drowsiness, sinus tachycardia, and nausea/vomiting were prevalent symptoms.
  • Hyperglycemia was the most frequent laboratory finding.
  • Six patients required intubation for respiratory failure; four fatalities occurred.

Conclusions:

  • Tricyclic antidepressant intoxication remains a critical cause of pediatric mortality and morbidity.
  • Early identification of clinical and laboratory findings associated with high-dose TCA ingestion is vital.
  • This study highlights the need for heightened awareness and prompt intervention in pediatric amitriptyline poisoning.
Abstract

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