Sarisoy Ozlem, Babaoglu Kadir, Tugay Sevinc, Barn Erdem, Gokalp Ayse Sevim
Department of Pediatrics, Kocaeli University Faculty of Medicine, Umuttepe Yerleskesi, Izmit, Kocaeli, Turkey.
Pediatr Emerg Care. 2007 Sep;23(9):646-8. doi: 10.1097/PEC.0b013e31814a6a95.
In our country, tricyclic antidepressants are usually present in most of the homes. Myocardial depression and ventricular arrhythmia are the severe side effects in tricyclic antidepressant overdose. A 4-year-old boy was brought to our hospital after taking 70 mg/kg of amitriptyline. On arrival, the patient was comatose (Glasgow Coma Score was 3), had a shallow breathing pattern with bradycardia (HR <30/min), and hypotension. He was intubated and resuscitated with multiple doses of adrenaline and sodium bicarbonate. He was infused with a bolus of 20 mg/kg of normal saline for hypotension. After 30 minutes, ventricular fibrillation was detected. Lidocaine and bicarbonate were not effective in converting the rhythm to normal, therefore, synchronized cardioversion was used. After cardioversion, the rhythm converted to ventricular tachycardia. Because ventricular tachycardia did not resolve, we administered a load of less than 2 g of magnesium sulfate for 30 minutes followed by a continuous infusion of 3 mg/min. After magnesium sulfate infusion, a normal cardiac rhythm was achieved. Magnesium sulfate is a very effective treatment in intractable arrhythmias caused by high-dose amitriptyline intoxication.
在我国，大多数家庭中通常都有三环类抗抑郁药。心肌抑制和室性心律失常是三环类抗抑郁药过量的严重副作用。一名4岁男孩服用了70mg/kg的阿米替林后被送往我院。到达时，患者昏迷（格拉斯哥昏迷评分3分），呼吸浅慢伴心动过缓（心率<30次/分钟）及低血压。予以气管插管，并多次静脉注射肾上腺素和碳酸氢钠进行复苏。因低血压给予20mg/kg的生理盐水静脉推注。30分钟后，检测到心室颤动。利多卡因和碳酸氢钠未能有效恢复正常心律，因此采用同步心脏复律。复律后，心律转为室性心动过速。由于室性心动过速未缓解，我们在30分钟内给予负荷量小于2g的硫酸镁，随后持续输注3mg/分钟。硫酸镁输注后，恢复了正常心律。硫酸镁是治疗大剂量阿米替林中毒所致顽固性心律失常的非常有效的药物。
