Pancreatic involvement associated with tricyclic overdose.

To our knowledge, only two cases of pancreatic involvement after tricyclic overdose have so far been described in the literature. We report another case of pancreatic involvement after tricyclic antidepressant overdose. Patient. A 30-year-old female was admitted to our Emergency Room after having ingested 800 mg of amitriptyline in a suicide attempt. On the second day of hospitalization, high serum values of amylase 823 IU/l (normal values < 220 IU/l) and lipase 1054 IU/l (normal value < 270 IU/l) were found. The pancreas appeared normal upon ultrasonography. Serum pancreatic enzymes further increased on the third day of hospitalization, peaked on the fourth day and then progressively decreased. Repeated ultrasonography examination did not show any alteration in the pancreatic gland. The patient was discharged eight days after admission. Fifteen days after the overdose episode, the ultrasonographic examination still did not show any alteration of the pancreatic gland, and serum amylase and lipase were 403 IU/l and 239 IU/l, respectively. In our opinion, serum pancreatic enzymes should be determined in patients with tricyclic overdose in order to detect possible pancreatic involvement.