Acute amitriptyline intoxication: an analysis of 44 children.
Level 4 - case-series / case-control
Uncontrolled clinical case series.
PubMed 16634328 · doi:10.1191/0960327106ht511oa
What was done
The authors reviewed the clinical and laboratory records of 44 children (aged 12 months to 14 years, mean 4.09 ± 2.9 years; 21 boys, 23 girls) presenting with acute amitriptyline overdose. All cases except one intentional ingestion were accidental.
What was found
Ingested doses ranged from 2 to 97.5 mg/kg (mean 13.6 ± 17.7 mg/kg; unknown in 13 patients). Common findings were lethargy, tachycardia, convulsions, hyperglycemia, and leukocytosis, while hypotension, arrhythmias, and respiratory insufficiency were infrequent. Two children died (one after 97.5 mg/kg from probable status epilepticus and one after 36 mg/kg from cardiopulmonary arrest). In the remaining 42 patients, abnormal findings resolved with supportive care and all were discharged in good health by day 4.
Why it matters
This series outlines the typical presentation and clinical course of pediatric amitriptyline poisoning, showing that supportive care is usually sufficient for recovery in non-fatal accidental ingestions.
Limits
This is a single-center retrospective case series without a comparator group. Ingestion amounts were unknown in nearly 30% of cases (13/44), exact supportive interventions were not detailed in the abstract, and long-term neurodevelopmental follow-up was not reported.
Cited by
- contradicts An overdose of 15 amitriptyline tablets is inherently lethal.