TY - JOUR
T1 - Imipramine poisoning in a child
T2 - Lack of efficacy of resin hemoperfusion
AU - Ryan, Maj Robert
AU - Wians, Capt Frank H.
AU - Stigelman, Lt Col William H.
AU - Clark, Hector
AU - McCurdy, Lt Col Fredrick
PY - 1985/12
Y1 - 1985/12
N2 - A three-year-old boy ingested up to 1,500 mg of the tricyclic antidepressant Imipramine (Tofranil). He entered our facility within two hours of discovery, and multiple resuscitative efforts, which proved unsuccessful, followed. Resin hemoperfusion was used in an effort to remove imipramine from the systemic circulation. Serum concentrations of imipramine and its major metabolite desipramine were determined from serum drawn before, during, and after hemoperfusion. Serum concentrations of imipramine and desipramine did not change appreciably. No improvement in the clinical condition was noted during the hemoperfusion period, which was due in part to the fact that our patient was clinically brain dead upon arrival in our intensive care unit. Our subsequent literature review documents that (1) this case represents the first reported use of hemoperfusion in a pediatric tricyclic antidepressant ingestion, (2) hemoperfusion removes an insignificant portion of the total amount of tricyclic antidepressant ingested, and (3) some pediatric literature misleadingly suggests that hemoperfusion may be useful in such patients. Physicians treating tricyclic antidepressant ingestion cases should avoid using hemoperfusion; standard supportive care remains the essential management response.
AB - A three-year-old boy ingested up to 1,500 mg of the tricyclic antidepressant Imipramine (Tofranil). He entered our facility within two hours of discovery, and multiple resuscitative efforts, which proved unsuccessful, followed. Resin hemoperfusion was used in an effort to remove imipramine from the systemic circulation. Serum concentrations of imipramine and its major metabolite desipramine were determined from serum drawn before, during, and after hemoperfusion. Serum concentrations of imipramine and desipramine did not change appreciably. No improvement in the clinical condition was noted during the hemoperfusion period, which was due in part to the fact that our patient was clinically brain dead upon arrival in our intensive care unit. Our subsequent literature review documents that (1) this case represents the first reported use of hemoperfusion in a pediatric tricyclic antidepressant ingestion, (2) hemoperfusion removes an insignificant portion of the total amount of tricyclic antidepressant ingested, and (3) some pediatric literature misleadingly suggests that hemoperfusion may be useful in such patients. Physicians treating tricyclic antidepressant ingestion cases should avoid using hemoperfusion; standard supportive care remains the essential management response.
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U2 - 10.1097/00006565-198512000-00008
DO - 10.1097/00006565-198512000-00008
M3 - Article
C2 - 3842167
AN - SCOPUS:0022322717
VL - 1
SP - 201
EP - 204
JO - Pediatric Emergency Care
JF - Pediatric Emergency Care
SN - 0749-5161
IS - 4
ER -