The Fatal Dose Amitriptyline Poisoning: Case Report

Öz

High dose amitriptyline poisoning is very important condition among emergency department visits. Particularly more than one gram of amitriptilin exposure may cause mortality. Most of the deaths occur in several hours after taking amitripitilin. Twenty three year old woman patient applied our emergency department with a complaint of unconsciousness after three grams amitriptyline exposure. At the inital approach of the patient, it was seen that cardiopulmoner collaps and myoclonic seizure had been developed. At her blood gas analysis, there was profound metabolic asidosis. Endotracheal entubation and antiepileptic drugs were applied to the patient. Also bicarbonate was given for her profound metabolic asidosis. Because of the patient's acidosis did not improve with conservative treatment, hemoperfusion was applied to her. After two days follow up at intensive care unit, the patient recovered completely. As a conclusion, high dose amytriptilline poisoning is a serious case for emergency departments and can be fatal but appropriate evaluation and management of these cases at the emergency department can make patients recover rapidly.

Anahtar Kelimeler

• -

Ölümcül Doz Amitriptilin Zehirlenmesi: Olgu Sunumu

Öz

Yüksek doz amitriptilin alımına bağlı zehirlenme acil servise başvuru nedenleri arasında önemini korumaktadır. Özellikle 1 gramdan daha fazla alındığında, amitriptilin zehirlenmesi hayatı tehdit eden bir durum olmaktadır. Ölümlerin birçoğu alımdan sonraki ilk birkaç saat içinde meydana gelir. Yirmi üç yaşındaki bayan hasta 3 gram amitriptilin aldıktan sonra bilinç kaybı ile acil servisimize getirildi. Olguda kardiyopulmoner kollaps gelişmişti. Miyoklonik tarzda nöbet geçirmekteydi. Kan gazında derin asidozu mevcuttu. Endotrakeal entübasyon ve antiepileptik ilaçlar uygulandı. Asidozu nedeniyle bikarbonat verildi. Asidozunun düzelmemesi üzerine hemoperfüzyon uygulandı. Yoğun bakıma yatırılan hasta 2. gün tamamen düzeldi. Sonuç olarak amitriptilin yüksek doz alımları hayatı tehdit edici zehirlenmelere neden olabilmekle birlikte acil serviste uygulanacak doğru yaklaşımla olgular tamamen iyileşebilmektedir.

Anahtar Kelimeler

• Amitriptilin, epileptik nöbet, hemoperfüzyon

Kaynakça

1. 1. Mills KC. Tricyclic Antidepressants. In: Tintinalli JE, Kelen GD, Stapczynski SJ (Editors). Emergecy Medicine: A Comprehensive Study Guide. 6th ed, USA: Mcgraw-Hill Companies, 2004; 1025- 1033.
2. 2. Hulten BA, Adams R, Askenasi R. Predicting severity of tricyclic antidepressant overdose. Clin Toxicol 1992; 30:161- 170.
3. 3. Rosenstein DL, Nelson JC, Jacobs SC. Seizures associated with antidepressants: a review. J Clin Psychiatry 1993; 54:289-299.
4. 4. Sandeman DJ, Alahakoon TI, Bentley SC. Tricyclic poisoning: successful management of ventricular fibrillation following massive overdose of imipramine. Anaesth Intensive Care 1997; 25:542-545.
5. 5. Frank RD, Kierdorf HP. Is there a role for hemoperfusion/ hemodialysis as a treatment option in severe tricyclic antidepressant intoxication? Int J Artif Organs 2000; 23:618- 623.,
6. 6. Nogué S, Marruecos L. Inefficacy of hemoperfusion in acute poisoning with tricyclic antidepressives. Med Clin 1992; 98:559.
7. 7. Dönmez O, Cetinkaya M, Canbek R. Hemoperfusion in a child with amitriptyline intoxication. Pediatr Nephrol 2005; 20:105- 107.
8. 8. Islek I, Degim T, Akay C, Turkay A, Akpolat T. Charcoal haemoperfusion in a child with amitriptyline poisoning. Nephrol Dial Transplant 2004; 19:3190–3191.

9. 9. Citak A, Soysal DD, Uçsel R, Karaböcüoglu M, Uzel N. Seizures associated with poisoning in children: tricyclic antidepressant intoxication. Pediatr Int 2006; 48:582–585.