PULMONARY COMPLICATIONS FOLLOWING TRICYCLIC ANTIDEPRESSANT OVERDOSE IN AN ADOLESCENT

OBJECTIVE: To report a case of pulmonary edema following a tricyclic a ntidepressant (TCA) overdose in an adolescent. CASE SUMMARY: A 14-year -old girl with a history of prior suicide attempts ingested 54 50-mg d esipramine hydrochloride tablets (45 mg/kg ingestion). The patient dev eloped a cardiac dysrhythmia and hypotension, which were successfully treated. She subsequently developed pulmonary edema and a clinical pic ture suggestive of adult respiratory distress syndrome (ARDS). She was successfully managed with fluid restriction, tracheal intubation, app lication of positive end-expiratory pressure (PEEP), and vasopressors. The patient was discharged without any clinical sequelae. DISCUSSION: Pulmonary complications secondary to TCA overdose have rarely been re ported in children. We reviewed literature pertaining to the etiology, epidemiology, pathophysiology, and management of TCA-induced lung inj ury, as well as other case reports. We discuss the potential relations hip between sequelae resulting from TCA ingestion (e.g., cardiac distu rbances, hypotension, acidosis, gastric aspiration, pneumonia) and the development of ARDS and pulmonary edema, and relate this association to our patient. CONCLUSIONS: Pulmonary edema and a clinical picture su ggestive of ARDS was noted in an adolescent girl who ingested a large quantity of desipramine. Her lung injury may have been the result of a variety of factors including hypotension, metabolic acidosis, possibl e aspiration, or a direct action on the lung parenchyma by desipramine . We attribute her favorable clinical outcome to early intervention co nsisting of tracheal intubation, PEEP, fluid restriction, and vasopres sor therapy.