Clinical Effects and Treatment of Imipramine and Amitriptyline Poisoning in Children

Abstract

Attention is drawn to the increasing incidence of poisoning due to the ingestion of imipramine and amitriptyline by young children. Twelve non-fatal cases are reported, and compared with 21 others in the literature, including five deaths. Mildly affected children exhibit drowsiness—sometines alternating with excitement—tachycardia, ataxia, and sometimes dilated pupils. In more severe cases convulsions and coma rapidly supervene. Arrhythmias and circulatory failure may occur and can prove fatal. These severe symptoms always appear when the ingested dose exceeds 20 mg./kg., though much smaller doses may suffice. Early gastric lavage is indicated. Peritoneal or extracorporeal dialysis is ineffective and forced diuresis is contraindicated. Treatment of the severe case is symptomatic. Paraldehvde is preferred to barbiturates in controlling convulsions. Xylocaine and pyridostigmine may have a place in the management of arrhythmias, but hypertensive agents are contraindicated. Careful observation should include E.C.G. monitoring. Sedation is required during recovery, and bed rest should continue for a minimum of three days. © 1967, British Medical Journal Publishing Group. All rights reserved.