Caksen Hüseyin, Akbayram Sinan, Odabaş Dursun, Ozbek Hanefi, Erol Mehmet, Akgün Cihangir, Tuncer Oğuz, Yilmaz Cahide
Department of Pediatrics, Yüzüncü Yil University, Faculty of Medicine, 65200, Van, Turkey.
Hum Exp Toxicol. 2006 Mar;25(3):107-10. doi: 10.1191/0960327106ht511oa.
The tricyclic antidepressant agents, particularly amitriptyline and dothiepin, are recognized for their potentially lethal cardiovascular and neurological effects in poisoned patients. In this article, the clinical and laboratory findings of 44 children with amitriptyline intoxication are reviewed. Our purpose was to investigate amitriptyline intoxication in childhood. Of 44 patients, 21 (47.7%) were boys, 23 (52.3%) were girls, and the ages ranged from 12 months to 14 years (mean +/- SD; 4.09 +/- 2.9 years). All children except one who took an overdose of amitriptyline to decrease his pain accidentally ingested an overdose of amitriptyline. The amount of amitriptyline ingested was between 2 mg/kg and 97.5 mg/kg (mean +/- SD; 13.6 +/- 17.7 mg/kg per dose) (the drug dosage was not known in 13 children). The most commonly observed clinical and laboratory findings were lethargy, tachycardia, convulsion, hyperglycemia and leukocytosis. In all patients except for two children who died the abnormal clinical and laboratory findings returned to normal within a few days after admission and they were discharged from the hospital in good health within the fourth day of admission. One of the children ingested 97.5 mg/kg amitriptyline and probably died due to status epilepticus and another child who died ingested 36 mg/ kg amitriptyline and died due to cardiopulmonary arrest. In conclusion, our findings showed that initial symptoms and signs of acute amitriptyline intoxication appeared severe, but they disappeared with only supportive care required in most children except for cases that ingested high doses of drug within a few days. In contrast to adults, we infrequently noted respiratory insufficiency, arrhythmia and hypotension in children with acute amitriptyline intoxication.
三环类抗抑郁药，尤其是阿米替林和多塞平，因其对中毒患者具有潜在致命的心血管和神经影响而为人所知。本文回顾了44例阿米替林中毒儿童的临床和实验室检查结果。我们的目的是研究儿童期阿米替林中毒情况。44例患者中，21例（47.7%）为男孩，23例（52.3%）为女孩，年龄范围为12个月至14岁（平均±标准差；4.09±2.9岁）。除1名儿童因服用过量阿米替林以减轻疼痛而意外中毒外，其他所有儿童均为误服过量阿米替林。阿米替林的摄入量在2mg/kg至97.5mg/kg之间（平均±标准差；每剂13.6±17.7mg/kg）（13名儿童的药物剂量不详）。最常见的临床和实验室检查结果为嗜睡、心动过速、惊厥、高血糖和白细胞增多。除2名死亡儿童外，所有患者的异常临床和实验室检查结果在入院后几天内恢复正常，并在入院后第四天健康出院。1名儿童摄入97.5mg/kg阿米替林，可能死于癫痫持续状态，另1名死亡儿童摄入36mg/kg阿米替林，死于心肺骤停。总之，我们的研究结果表明，急性阿米替林中毒的初始症状和体征看似严重，但在大多数儿童中，除了在几天内摄入高剂量药物的情况外，仅需支持治疗症状就会消失。与成人不同，急性阿米替林中毒儿童中我们很少注意到呼吸功能不全、心律失常和低血压。
