A case of imipramine induced toxicity with Brugada electrocardiographic pattern in a toddler.
10.3345/kjp.2008.51.11.1232
- Author:
Woo Yeon CHOI
1
;
Soo Min PARK
;
Ui Jeong HAN
;
Young Nam KIM
;
Young Kuk CHO
;
Jae Sook MA
Author Information
1. Department of pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwang-Ju, Korea. cardiol@jnu.ac.kr
- Keywords:
Tricyclic antidepressant;
Imipramine;
Brugada electrocardiographic pattern
- MeSH:
Anxiety Disorders;
Arrhythmias, Cardiac;
Central Nervous System;
Child;
Coma;
Delirium;
Depression;
Dihydroergotamine;
Electrocardiography;
Hallucinations;
Humans;
Ileus;
Imipramine;
Korea;
Mouth;
Myocardium;
Neuralgia;
Nocturnal Enuresis;
Psychomotor Agitation;
Pupil;
Seizures;
Sodium;
Sodium Bicarbonate;
Tachycardia;
Tachycardia, Sinus;
Urinary Retention
- From:Korean Journal of Pediatrics
2008;51(11):1232-1235
- CountryRepublic of Korea
- Language:English
-
Abstract:
Imipramine, a tricyclic antidepressant (TCA), is used for the treatment of non-polar depression and nocturnal enuresis in children in whom an organic pathology has been excluded, anxiety disorders, and neuropathic pain. Clinical toxicity following the treatment of TCAs, including imipramine, is well known. The anticholinergic effects initially present include a dry mouth, ileus, dilated pupils, urinary retention, and mild sinus tachycardia. The central nervous system toxicity includes delirium, agitation, restlessness, hallucinations, convulsions, and CNS depression or coma. However, the most life-threatening toxicity remains the development of cardiac dysrhythmias. Conduction delays such as QRS and corrected QT prolongation, wide QRS complex tachycardia, and the Brugada electrocardiographic pattern have been reported. Sodium bicarbonate decreases QRS widening and suppresses dysrhythmias by providing excess sodium to reverse the TCA-induced sodium-channel blockade and possibly by binding directly to the myocardium. There are no pediatric case reports on imipramine or other TCA associated toxicity in Korea. Here, we describe a patient who presented with convulsions, tachycardia with a wide QRS complex, a Brugada electrocardiographic pattern, and anuresis associated with an accidental overdose of imipramine and the outcome of treatment with sodium bicarbonate.
