Citation

Saygi, Gül H, Macit E, Yamanel L. Ankara Universitesi Eczacilik Fakultesi Dergisi 2004; 33(4): 255-267.

Copyright

(Copyright © 2004)

DOI

unavailable

PMID

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Abstract

Tricyclic antidepressant drugs (TCA) are the second widely used drugs after the analgesics, and involve in acute poisoning cases. In this study we measured unusual high dose of TCA levels in three suicidal poisoning cases. Toxicological screening on patients urine and blood samples were performed with GC/MS, and the quantitation of drugs were done with GC/MS and FPIA methods. Amitriptyline, acetaminophen, and codeine levels were 1135 ng/ml blood, 14.42 μg/ml blood, and 72.9 μg/ml urine respectively in case 1. Amitriptyline levels were found as 505, 429, and 370 μg/ml blood for consequent three days. In Case 2, amitriptyline levels were 883.56 and 137.35ng/ml blood for two days. In Case 3, initial imipramine level was 2560 ng/ml blood. First two patients were fully recovered 4 days after the incident. The third patient died 36 hours after the admission. In acute poisoning cases, early emergency teratment, obtaining rapid and reliable toxicological laboratory results were considered vitally important in poisoning cases.; Patients:One 17-year-old female patient.; TypeofStudy:Suicide by ingestion of Tofranil tablets was reported. Case report.; DosageDuration:Ingestion of 100 tablets (25 mg/tablet) and 50 tablets (10 mg/tablet). Total dose: 3000 mg.; Results:On examination, her vital signs were absent. Cyanosis, dilated and fixed pupils and no response to pain stimuli were also noted. She was immediately resuscitated. Gastric lavage and activated charcoal were also performed. The patient's blood pressure, pulse rate, and body temperature were recorded. The patient was mechanically ventilated and her blood pressure was maintained with saline and dopamine. Initial Tofranil blood level was 2560 ng/ml. Toxicological screening with FPIA was positive for Tofranil. Tofranil was later confirmed with the GC/MS method in both blood and urine samples. The patient died 34 hours after admission.; AdverseEffects:One patient had a fatal cardiopulmonary arrest.; FreeText:The patient was brought to the emergency department with a history of suicidal ingestion of 100 tablets (25 mg/tablet) and 50 tablets (10 mg/tablet) of Tofranil with cardiopulmonary arrest. Laboratory test: hemoglobin, glucose, urea, creatinine, sodium, potassium, aspartate aminotransferase blood level (SGOT), alanine aminotransferase blood level (SGPT), arterial blood gases, toxicological screening test, gas chromatography and mass spectrometry (GC/MS) and fluorescence polarization immunoassay (FPIA). Other tests: Tofranil in blood and urine, heart rate, blood pressure, body temperature.

Language: en

Keywords

adult; human; naloxone; female; male; case report; suicide attempt; Acetaminophen; intoxication; article; mass spectrometry; amitriptyline; imipramine; tricyclic antidepressant agent; stomach lavage; coma; dopamine; paracetamol; activated carbon; cyanosis; electrolyte; drug blood level; drug urine level; gas chromatography; artificial ventilation; disorientation; codeine; sodium chloride; glucose; cardiopulmonary arrest; stomach mucosa; thiamine; blood pressure; Codeine; fluorescence polarization immunoassay; FPIA; GC/MS; omeprazole; stimulus response; Tricyclic antidepressants; unconsciousness