Respiratory distress syndrome and thrombotic, non-bacterial endocarditis after amitriptyline overdose

Three patients with documented or suspected amitriptyline poisoning developed a uniform clinical picture with progressive respiratory insufficiency, thrombocytopenia and evidence of embolization. Post-mortem examination revealed equally uniform changes: thrombotic, non-bacterial endocarditis (TNBE) with multiple embolization and marked pulmonary stiffness with extensive invasion of alveoli with connective tissue. The lung pathology and clinical picture of progressive respiratory insufficiency are in agreement with the respiratory distress syndrome (RDS) in the adult. The simultaneous occurrence of RDS and TNBE suggests a similar pathogenesis. Prophylactic measures are described.