Poisoning with tricyclic antidepressants: an avoidable cause of childhood deaths.

Cronin, Aaron; Rostami, Khalil; Little, T M

doi:10.1136/bmj.1.6165.722

Cited by 13 publications

(7 citation statements)

References 1 publication

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“…The longest documented time to onset of toxicity was 6 hours after an ingestion of imipramine by a young child (50). In one report (level 4), a 4-year-old boy with enuresis drank 90 mL imipramine syrup (32 mg/kg), was given a salt-water mixture by his mother, vomited, "went to sleep," and 4 hours later developed convulsions and then ventricular tachycardia and fibrillation (150). A 44-year-old man taking 75 mg amitriptyline daily for months to treat depression ingested 750 mg and presented to an emergency department 16 hours later with only drowsiness as a symptom of toxicity (155).…”

Section: Time Of Onsetmentioning

confidence: 99%

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Woolf

Erdman

Nelson

et al. 2007

Clinical Toxicology

130

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of U.S. poison center data for 2004 showed over 12,000 exposures to tricyclic antidepressants (TCAs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce healthcare costs, and reduce life disruption for patients and caregivers. An evidencebased expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate prehospital triage and management of patients with suspected ingestions of TCAs by 1) describing the manner in which an ingestion of a TCA might be managed, 2) identifying the key decision elements in managing cases of TCA ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of TCAs alone. Co-ingestion of additional substances could require different referral and management recommendations depending on their combined toxicities. This guideline is based on the assessment of current scientific and clinical information. The panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) Patients with suspected self-harm or who are the victims of malicious administration of a TCA should be referred to an emergency department immediately (Grade D). 2) Patients with acute TCA ingestions who are less than 6 years of age and other patients without evidence of self-harm should have further evaluation including standard history taking and determination of the presence of co-ingestants (especially other psychopharmaceutical agents) and underlying exacerbating conditions, such as convulsions or cardiac arrhythmias. Ingestion of a TCA in combination with other drugs might warrant referral to an emergency department. The ingestion of a TCA by a patient with significant underlying cardiovascular or neurological disease should cause referral to an emergency department at a lower dose than for other individuals. Because of the potential severity of TCA poisoning, transportation by EMS, with close monitoring of clinical status and vital signs en route, should be considered (Grade D). 3) Patients who are symptomatic (e.g., weak, drowsy, dizzy, tremulous, pal...

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Section: Time Of Onsetmentioning

confidence: 99%

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Woolf

Erdman

Nelson

et al. 2007

Clinical Toxicology

130

View full text Add to dashboard Cite

show abstract

“…Studies on poisoning in children have focused, in the main, either on medicinal poisoning or on nonmedicinal agents. [1][2][3][4][5] Comparative studies of medicinal and non-medicinal poisoning in the same population seem uncommon. In this paper, we therefore report on hospital admission rates and trends from 1975 to 1986, comparing medicinal and non-medicinal poisoning in preschool children residing in six health districts in southern England.…”

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confidence: 99%

Some epidemiological observations on medicinal and non-medicinal poisoning in preschool children.

Ferguson

Sellar

Goldacre

1992

Journal of Epidemiology & Community Health

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“…A review of English language literature over the past 40 years yields several case reports where a mere one to two pills (10 -20 mg/kg) sufficed to kill a toddler (Table 1) (42)(43)(44)46,52,54,(57)(58)(59)(60)(61)(62). With reference to Table 1, the case reports of fatalities involving amitriptyline, desipramine, and imipramine all occurred with doses equal to or greater than 15 mg/kg, most over 30 mg/kg.…”

Section: Tricyclic Antidepressant Toxicity In Childrenmentioning

confidence: 94%

Are one or two dangerous? Tricyclic antidepressant exposure in toddlers

Rosenbaum

Kou

2005

The Journal of Emergency Medicine

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Poisoning with tricyclic antidepressants: an avoidable cause of childhood deaths.

Cited by 13 publications

References 1 publication

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Some epidemiological observations on medicinal and non-medicinal poisoning in preschool children.

Are one or two dangerous? Tricyclic antidepressant exposure in toddlers

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