Amitriptyline and imipramine poisoning in children

Area of Science:

• Pediatrics
• Toxicology
• Cardiology

Background:

• Increasing hospital admissions of children due to tricyclic antidepressant (TCA) poisoning.
• Half of the cases occurred in the 18 months preceding the study.
• A significant percentage of TCAs were prescribed for childhood nocturnal enuresis.

Purpose of the Study:

• To highlight the growing concern of TCA poisoning in pediatric patients.
• To emphasize the need for immediate hospitalization and cardiac monitoring for all TCA overdose cases in children.
• To investigate the link between TCA prescriptions for enuresis and poisoning incidents.

Main Methods:

• Retrospective review of pediatric hospital admissions for tricyclic antidepressant poisoning.
• Analysis of patient demographics, prescribed indications for TCAs, and outcomes.
• Case review of fatalities and severe adverse events.

Main Results:

• 60 children admitted for TCA poisoning between 1966 and 1973.
• 60% of poisonings involved TCAs prescribed for nocturnal enuresis.
• One fatality due to imipramine poisoning in a young child.
• Cardiac arrhythmias were identified as a significant and dangerous complication.

Conclusions:

• Tricyclic antidepressant poisoning in children is a serious and increasing problem.
• Continuous cardiac monitoring is essential for all children with TCA poisoning, regardless of dose.
• Healthcare providers must counsel parents on the risks of TCAs, even when prescribed for conditions like enuresis.