Tahir YOLDAŞ, Sertaç GÜLER, Selda GÜLER, Nalan GÜNEŞ, Burcu ÇOKAL, Mustafa YURTDAŞ

Mortal Seyreden Bir Amitriptilin İntoksikasyonu Olgusu

ÖzetTrisiklik antidepresanların (TCA) aşırı alımı, ciddi ilaç zehirlenmelerinin en sık sebeplerinden biridir. Görece düşük (10 mg / kg) bir dozda amitriptilinin intihar etmek amacıyla içimi sonrası TCA zehirlenmesine bağlı çok şiddetli nörolojik ve kardiyovasküler belirtiler gösteren 20 yaşında bir kadın hastayı sunuyoruz. Gastrik lavaj, aktif kömür, sistemik alkalinizasyon (pH 7.50 olacak şekilde), destek tedavi ve plazma değişim tedavileri hasta için yeterli olmadı. Hastanın derin koma durumu ve şok tablosu devam etti ve herhangi bir önlem hastayı hayatta tutmaya yetmedi. Bu vaka, TCA zehirlenmesinin önemini ve bu zehirlenmenin düşük dozlarda dahi ölümcül olabileceğini vurgulamaktadır.

Anahtar Kelimeler:

Amitriptilin, aşırı dozda ilaç alımı, zehirlenme, intihar

A Case Report of Mortal Intoxication of Amitriptyline

Tricyclic antidepressant (TCA) overdose is one of the most common causes of serious drug poisonings. We here report a case with neurologic and cardiovascular manifestations of TCA intoxication following self-poisoning with amitriptyline in a relatively low dose of 10 mg/kg, in a 20-year-old female. Management with gastric lavage, activated charcoal, systemic alkalinization (pH 7.50), supportive care and plasma exchange therapy were not enough for the patient. Deep coma and shock persisted and no measures were enough to keep the patient alive. This case focuses on the importance of TCA intoxication and emphasizes that it can be fatal even at relatively low doses.

Keywords:

Amitriptyline, drug overdose, intoxication, suicide,

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Hazell P, Mirzaie M. Tricyclic drugs for depression in children and adolescents. Cochrane Database Syst Rev 2013;18(6):CD002317( doi:10.1002/14651858).
Watson WA, Litovitz TL, Klein-Schwartz W, Rodgers GC Jr, Youniss J, Reid N, et al. 2003 Annual report of the American
Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2004;22(5):335–404.
Bronsetin AC, Spyker DA, Cantilena LR, Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American
Association of Poison Control Centers’ National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Philia) 2010;48(10):979–1178.
Rosenbaum TG, Kou M. Are one or two dangerous? Tricyclic antidepressant exposure in toddlers. J Emerg Med 2005;28(2):169–174.
Olgun H, Yildirim ZK, Karaca M, Ceviz N. Clinical, electrocardiographic, and laboratory findings in children with amitriptyline intoxication. Pediatr Emerg Med 2009;25(3):170–
Liebelt EL, Francis PD, Woolf AD. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Ann Emerg Med 1995;26(2):195–201.
Body R, Bartram T, Azam F, Mackway-Jones K. Guidelines in Emergency Medicine Network (GEMNet): guideline for the management of tricyclic antidepressant overdose. Emerg Med J 2011;28(4):347–68.
Belen B, Akman A, Yüksel N, Dilsiz G, Yenicesu I, Olguntürk R. A case report of amitriptyline poisoning successfully treated with the application of plasma exchange. Ther Apher Dial 2009;13(2):147-9.
Harvey M, Cave G. Case report: successful lipid resuscitation in multi-drug overdose with predominant tricyclic antidepressant toxidrome. Int J Emerg Med 2012;5(1):8.
Ozayar E, Degerli S, Gulec H. Hemodiafiltration: a novel approach for treating severe amitriptyline intoxication. Toxicol Int 2012;19(3):319-21.
Yazışma Adresi / Correspondence Dr. Sertaç Güler Ankara Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, Ankara / TÜRKİYE Tel: +90 532 554 83 88 e-posta: drsertacguler@gmail.com Geliş Tarihi: 18.03.2014 Kabul Tarihi: 27.05.2014 Yoldaş ve arkadaşları 14