The Turkish Journal of Pediatrics
2013 , Vol 55 , Num 6
Severe childhood amitriptyline intoxication and plasmapheresis: a case report
1Department of Pediatrics and 2Department of Family Medicine and Blood Banking Unit, Bülent Ecevit University, Faculty
of Medicine, Zonguldak, Turkey. E-mail: mkaraci@gmail.com
Tricyclic antidepressant intoxication is one of the most frequently encountered
and life-threatening causes of intoxication among referrals to emergency
departments due to drug intoxication. There is no known antidote against
any of the tricyclic antidepressants. The American Society for Apheresis
(ASFA) recommends plasmapheresis to support primary treatment in this
type of drug poisoning, which does not respond to certain and traditional
treatments. We present a 15-year-old girl who ingested amitriptyline with
suicidal intent. On admission, she was in a comatose state (Glasgow Coma
Scale score: 5), with no spontaneous respiration and presence of pathological
reflexes. Due to the intake history of lethal doses and the severe clinical
picture, plasmapheresis was performed. She was discharged on her fifth day
of hospitalization.
Due to the high plasma protein binding property of amitriptyline, plasma exchange therapy should be considered in cases of severe amitriptyline intoxication as a life-saving therapeutic modality.
Keywords : amitriptyline, childhood, intoxication, plasmapheresis.