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Paediatric tricyclic antidepressant overdose

02 December 2011
Volume 3 · Issue 12

Abstract

A case of paediatric tricyclic antidepressant (TCA) ingestion is discussed in this article. Ingestions, especially from TCAs, are potentially life-threatening, requiring prompt recognition and treatment. Successfully treating a TCA ingestion hinges on the recognition of both the availability of TCAs to the patient and the signs and symptoms of TCA ingestion. Unfortunately, once TCA ingestion is identified, there is variability in management by emergency medical services (EMS), leading to variability in outcomes. The diagnosis and management of TCA ingestion are reviewed in this case study, as well as barriers that prehospital care providers encounter in diagnosing and treatment.

Suicide by ingestion is a serious health issue, accounting for 30 000 deaths and approximately US$ 1.6 billion in lost income to the US annually. (Goldsmith et al, 2002). Although a problem throughout all age groups, in 2007, suicide was the third leading cause of death for young people aged 15-24 in the US (Center for Disease Control and Prevention, 2011). In the most recent annual report from the American Association of Poison Control Centers, there were 70 294 toxic exposures to antidepressants alone, accounting for 6.5% of the total deaths associated with toxic ingestion (Bronstein et al, 2010).

Tricyclic antidepressants (TCA) are the most common group of medications encountered in antidepressant poisoning (Phillips et al, 1997; Bosch et al, 2000; McFee et al, 2001; Graudins et al, 2002; Arranto et al, 2003; Unverir et al, 2006). Further confounding the danger of TCA ingestion is the predilection for direct cardiac effects. As with other toxic antidepressant ingestions, tachycardia is the most common electrocardiogram (ECG) finding (Fasoli and Glauser, 1981; Niemann et al, 1986; Mills, 2000; Benowitz, 2004; Liebelt and Francis, 2002; Unverir et al, 2006); however, TCA ingestions account for the vast majority of abnormal ECG findings. TCA ingestions have a higher rate of cardiovascular effects—including, conduction disturbances, dysrhythmias, and hypotension (White et al, 2008).

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