OJPed  Vol.2 No.2 , June 2012
Paediatric amitriptyline overdose
Abstract: We report a near fatal case of paediatric amitriptyline overdose including a series of ECGs demonstrating the effects of sodium bicarbonate therapy on cardio-toxicity. We briefly discuss the role of sodium to counteract the sodium channel blockade of tricyclic antidepressants and discuss the possible utility of lipid emulsion therapy in such cases.
Cite this paper: Doherty, S. , Cave, G. and Harvey, M. (2012) Paediatric amitriptyline overdose. Open Journal of Pediatrics, 2, 170-174. doi: 10.4236/ojped.2012.22028.

[1]   Soghoian, S., Doty, C.I., Maffei, F.A. and Connolly, H. Toxicity, tricyclic antidepressant. eMedicine Paediatrics.

[2]   Emergency Medicine Expert Group (2008) Therapeutic guidelines: Toxicology and wilderness. Version 1. Therapeutic Guidelines Limited, Melbourne.

[3]   McCabe, J.L., Cobaugh, D.J., Menegazzi, J.J. and Fata, J. (1998) Experimental tricyclic antidepressant toxicity: A randomized, controlled comparison of hypertonic saline solution, sodium bicarbonate, and hyperventilation. Annals of Emergency Medicine, 32, 329-333. doi:10.1016/S0196-0644(98)70009-5

[4]   McKinney, P.E. and Rasmussen, R. (2003) Reversal of severe tricyclic antidepressant-induced cardiotxicity with intravenous hypertonic saline. Annals of Emergency Medicine, 42, 20-24. doi:10.1067/mem.2003.233

[5]   Harrop, G.W., Picard, J., Meek, T., et al. (2010) AAGBI safety guideline, management of severe local anaesthetic toxicity.

[6]   Toxbase Database Information (2010) Amitryptiline. UK National Poisons Information Centre.

[7]   Harvey, M. and Cave, G. (2007) Intralipid outperforms sodium bicarbonate in a rabbit model of clomipramine toxicity. Annals of Emergency Medicine, 49, 173-185. doi:10.1016/j.annemergmed.2006.07.016

[8]   Bania, T.C. and Chu, K. (2006) Hemodynamic effect of intralipid on amitryptilline toxicity. Annals of Emergency Medicine, 13, S177. doi:10.1197/j.aem.2006.03.448

[9]   Harvey, M., Cave, G. and Hoggett, K. (2009) Correlation of plasma and peritoneal diasylate clomipramine concentration with hemodynamic recovery after intralipid infusion in rabbits. Academic Emergency Medicine, 16, 151-156. doi:10.1111/j.1553-2712.2008.00313.x

[10]   Carr, D., Boone, A., Hoffman, R.S., Martin, K. and Ahluwalia, N. (2009) Successful resuscitation of a doxepin overdose using intravenous fat emulsion (IFE). Clinical Toxicology, 47, 710.

[11]   Al-Duaij, N., George, M., O’Donnell, K., et al. (2009) Lipid emulsion therapy in massive imipramine overdose. Clinical Toxicology, 47, 460.

[12]   Geib, A.J., Manini, A. and Liebelt, E. (2009) Case series of intravenous lipid emulsion rescue for drug cardiotoxicity. Clinical Toxicology, 47, 704.

[13]   Minton, N., Goode, A. and Henry, J. (1987) The effect of a lipid suspension on amitryptiline disposition. Archives of Toxicology, 60, 467-469. doi:10.1007/BF00302392