Citation

Hermanns-Clausen M, Rauch F. Intensivmedizin und Notfallmedizin 2004; 41(2): 99-104.

Copyright

(Copyright © 2004)

DOI

10.1007/s00390-004-0436-1

PMID

unavailable

Abstract

A 54-year old woman with a history of depression and previous suicide attempts was found comatose (GCS 3) and hypothermic (34 °C). An empty package of amitriptyline tablets was found suggesting an overdose of 10 g amitriptyline. She was transported to the hospital. One hour later the patient's respiration worsened and she was intubated and ventilated. Bronchopneumonia of the left lung due to aspiration required 8 days of mechanical ventilation. Amitriptyline concentration in the plasma was 1988 μg/l 22 hours postadmission. Focal epileptic seizures at day 3 and 4 were treated efficaciously with midazolam. An electrocardiogram revealed a widened QRS interval (148 ms) and QT prolongation (QTc = 502 ms), but only single VES were seen. Hypocalcemia was measured 10 hours after admission and required substitution of calcium for 7 days. At this time the QRS and QT intervals were normal again. After 20 days the patient could be transferred to the psychiatry department. Hypocalcemia has not been described in tricyclic antidepressiva overdose. The underlying mechanism is unclear. It may be caused by interference of amitriptyline with potassium channels in kidney.

Language: de

Keywords

adult; human; female; hypothermia; case report; depression; suicide attempt; disease severity; drug overdose; article; disease association; amitriptyline; tricyclic antidepressant agent; coma; drug blood level; QT interval; artificial ventilation; drug effect; hypocalcemia; QT prolongation; electrocardiogram; endotracheal intubation; tablet; aspiration pneumonia; midazolam; calcium; Amitriptyline overdose; calcium blood level; Cyclic antidepressants; focal epilepsy; Hypocalcemia; potassium channel; QRS complex