Charcoal hemoperfusion in an infant with supraventricular tachycardia and seizures secondary to amitriptyline intoxication

Abstract

<jats:p> Tricyclic antidepressant (TCA) overdose is one of the common causes of drug poisoning and it has cardiovascular, respiratory and neurological side effects. An 18-month male infant was admitted to our pediatric emergency service due to poisoning with amitriptyline. The infant was unconscious. Tachycardia, irregular and shallow breathing, and tonic-clonic seizures were observed on physical examination. An electrocardiogram displayed a narrow complex tachycardia that was consistent with re-entrant supraventricular tachycardia (SVT). Although antiarrhythmic and anticonvulsive agents were administrated, SVT and seizures persisted. Charcoal hemoperfusion (HP) was performed for 4 hours. The infant’s clinical condition has improved after the charcoal HP, seizures and SVT were not observed. It is concluded that charcoal HP can be used efficiently in patients with severe amitriptyline intoxication. </jats:p>

Extracorporeal Treatment for Tricyclic Antidepressant Poisoning: Recommendations from the EXTRIP Workgroup

“…From the initial 1312 studies obtained, 77 studies met the inclusion criteria, including 1 observational study , 5 animal studies , 4 in vitro studies , 4 pharmacokinetic (PK) studies , and 63 case reports , 39 of which had sufficient toxicokinetic (TK) data. In total, 108 patients were included for analysis.…”

“…Despite several anecdotal reports suggesting a benefit, current recommendations from widely consulted resources explicitly recommend against ECTR in TCA‐poisoned patients . Some recent reviews and publications nevertheless advocate these therapies, including plasmapheresis, hemodialysis, and hemoperfusion for severely poisoned TCA patients . One guideline reviewing the management of tricyclic overdose does not comment on the therapeutic use of ECTR .…”

Successful therapy with hemoperfusion and plasma exchange in acute 1,2,3-trichloropropane poisoning

“…HP has been used for toxin overdoses for several decades. 5,6 It has been proven that HP plays a role in the extracorporal elimination of 1,2,3-TCP. 7 In our study, we used HP with a styrene/divinylbenzene copolymer which can be used to clear poisons that have a large molecular weight, high lipid solubility, and a strong protein-binding ability.…”

“…HP has been used for toxin overdoses for several decades. 5,6 It has been proven that HP plays a role in the extracorporal elimination of 1,2,3-TCP. 7…”