CYCLIC ANTIDEPRESSANT TOXICITY IN CHILDREN AND ADOLESCENTS

We retrospectively evaluated the clinical and laboratory findings of a ll patients admitted to our facility during a 6.5-year period with a h istory of cyclic antidepressant ingestion (CAD). Outcome parameters [a dmission CAD concentration, arterial pH, and corrected QT (QTc) and QR S intervals] used in adult populations to predict morbidity after CAD ingestion were applied to our study population. During the study perio d, 45 patients (mean +/-SD age of 11.8 +/- 5.6 years) were admitted wi th CAD ingestion. Conduction delays were present in 17 patients, 9 of whom had QTc intervals greater than 0.43 seconds. Seven patients had g eneralized seizures; 7 required mechanical ventilation; 14 had Glasgow Coma Scores of 8 or lower on presentation; and one required pharmacol ogic support for hypotension. In our cohort, the mean admission serum CAD concentration was 461.5 +/- 477.4 ng/mL, Correlations were found b etween the arterial pH, the QRS interval, the QTc interval, and the ad mission CAD serum concentration. In an analysis of three subsets of pa tients (i.e., those with seizures, coma, and respiratory insufficiency ), only patients who presented with seizures were found to have a sign ificant prolongation in the QRS and QTc intervals. Pediatric patients who have ingested CADs and present with seizures would appear to be at increased risk for having conduction delays, cardiac dysrhythmias, an d, presumably, attendant morbidity and mortality associated with an in gestion.