Abstract

Tricyclic antidepressants are widely used drugs for treatment of depression despite serious mortality and morbidity in higher doses. They can cause severe cardiac arrhythmias, hypotension and central nervous system depression. Some patients may remain unresponsive in spite of conventional therapies such as gastric lavage and activated charcoal administration, benzodiazepines, volume replacement, lidocaine and sodium bicarbonate infusion. In this paper we report a 20-year-old female patient who had severe amitriptyline intoxication with a Glasgow Coma Scale score 4 and severe cardiac arrhythmias and was treated with hemodiafiltration. Conventional therapy was inadequate and hemodiafiltration was applied to the patient for 36 hours. At the end of the 36-hours the patient was conscious and became stabilized in terms of hemodynamics. In case of serious intoxication that does not respond to conventional therapy, approaches like hemodialysis, plasmapheresis, hemoperfusion and hemodiafiltration can be a rescue therapy and they should be considered.

Keywords: Amitriptyline, hemodiafiltration, tricyclic antidepressive agents

References

  1. Şahin G, Giray B, Erkekoğlu P. Treatment Approaches in Tricyclic Antidepressant Poisoning: Rewiev. Turkiye Klinikleri J Med Sci 2008;28:533-43.
  2. Özcan N, İkincioğullar D. [Ulusal Zehir Danışma Merkezi 2008 yılı Çalışma Raporu Ozeti] Türk Hij Den Biyol Derg 2009;66(Özel Sayıs 3).
  3. Ericksen SE. Recent advances in antidepressant drug treatment. West J Med 1979;131:104-13.
  4. Levine M, Brooks DE, Franken A, Graham R. Delayed-onset seizure and cardiac arrest after amitriptyline overdose, treated with intravenous lipid emulsion therapy. Pediatrics 2012;130:432-8.
  5. Brook DE, Levine M, O’Connor AD, French RNE, Curry SC. Toxicology in the ICU: Part 2: specific toxins. Chest 2011;140:1072-85.
  6. Ellenhorn MJ, Schonwald S, Ordog G, Wassenberger J. Cyclic Antidepressants. Ellenhorn’s Medical Toxicology: Diagnosis and Treatment in Human Poisoning. In: Ellenhorn MJ, Schonwald S, Ordog G, Wassenberger J, editors. 2nd ed. Baltimore: William; 1998. p. 30.
  7. Ozayar E, Degerli S, Gulec H. Hemodiafiltration: A novel Approach for treating severe amitriptyline intoxication. Toxicol Int 2012;19:319-21.
  8. Dumovic P, Burrows GD, Vohra J, Davies B, Scoggins BA. The effect of tricyclic antidepressant drugs on the heart. Arch Toxicol 1976;35:255-62.
  9. Acar E, Latif D, Yener N, Bülbül B, Karaca A, Ateş A. Ciddi Amitriptilin Zehirlenmesinde Hemoperfüzyon (Hemoperfusion In Severe Amitriptyline Intoxication) Akatos 2011;2:22-4.
  10. Karacı M, Özçetin M, Dilsiz G, Güçlü-Songür YG. Severe childhood amitriptyline intoxication and plasmapheresis: a case report. Turk J Pediatr 2013;55:645-7.
  11. Yates C, Galvao T, Sowinski KM, Mardini K, Botnaru T, Gosselin S, et al. “Extracorporeal treatment for tricyclic antidepressant poisoning: recommendations from the EXTRIP Workgroup. Semin Dial 2014;27:381-9.
  12. Dargan PI, Colbridge MG, Jones AL. The management of tricyclic antidepressant poisoning: the role of gut decontamination, extracorporeal procedures and fab antibody fragments. Toxicol Rev 2005;24:187-94.

Copyright and license

Copyright © 2018 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Sabuncu Ü, Abdullayev R, Duran M, Güler A, Selçuk Kuşderci H. Hemodiafiltration Practice in a Patient with Severe Amitriptyline Intoxication. Turk J Intensive Care. 2018;16(2):79-82. https://doi.org/10.4274/tybd.32559