The evaluation of children with amitriptyline overdose whose place into our hospital

ABSTRACTObjective: Amitrityline is used quite much in Turkey because it is effective, inexpensive and it is tricyclic antidepressant that can be taken without a prescription. Amitriptyline toxication rates within recent years show an incearse in childhood toxication, either by accidentally or by suicide attemp. In this study, clinical, epidemiological and prognostic characteristics of the patients attemp to the pediatric emergency room and hospitalized amitriptyline intoxication circumstances are examined retrospectively and, underlines the treatment offers.Materials and Methods: In this study, the patients attemped to Dicle University Medical School Pediatric Health and Disease Late Childhood, Nurseling Childhood Room and Intensive Care Unit between 01.01.2006 and 01.06.2007 with amitriptyline diagnosis are investigated and 41 phenomenon, demographic specialities, reasons of taking drugs, length of the hospitalization time, the medical unit first applied by the patient, first copmlaining of the patient, first intervention done by the first medical unit applied by the patient, Glaskow Koma Scales, duration of hospitalization and treatment, clinical symptoms and prognosis are retrospectively checked.Results: %56.1 of the 41 patients were female, %43.9 male, age range is 4.34±3.19 (min 1 year, max 14 year). %88 from downtown area and %22 from country side. The reasons of using amitriptyline: %82.9 were accidentally %17.1 were suicide attemp. %78 of the patients took the drugs which their parents use, %14.6 took the drug after they found it on the street, %7.3 took the drug in a visit. The enterence period to the hospital took min 10min, max 720 min and mean is 131,92±149,06, known doses at 31 patients were 5.20±4.19 mg/kg. %12,2 of those were did not get gastric lavage, %22 of those did not get active coal when they were under therapy of first medical clinic applied by the patients. The Glaskow Koma Scales of the intoxication cases were approximately 11.66±3.90 and the most common complaint was %51,3 the complaint of shelving to sleep. %34,1 of the intoxication cases had arrhythmia, %19,5 of those had convulsion, %17,1 had metabolic acidosis, %17,1 had hyponatremia, %14,6 had aspiration arrest, %12,2 had hypotension. The most common arrhytmia was the sinus tachycardia with the percentege of %50. In clinic %8,9 got gastric lavage, %17,2 got active coal, %46,9 got series of active coal. The urine alkalinization was performed to %53,7 of intoxication cases. %14.6 of the patients needed mechanical ventilation. %66.1 of the patients were had intensive care, the intensive care duration was approximately 2.26±1.27days, hospitalization period was 1.85±0.79days. A patient has died with a reason of arrhythmia and shortness of breath.Conclusion: Most of the cases are between 0-5 yerars old. The rate of amitriptiline overdose to suicide is high among girls bigger than 10 years old. It has sean that rate of respiratory insuffıency and seizure is higher than other studies. The amitriptyline toxication frequency have been increasing as it shown in many reports, and in some cases it appears as the most common toxication in childhood, the intensive care is needed and there can be a critical consequence such as mortality. The ?child safe? lids are needed and Ministry of Health must take care of this issue. Only the specialists must prescript, it must be given under green prescription. The families that uses these drugs must be instructed and be warned about harms of these drugs on kids.