Intentional Poisoning with Lethal Dose of Imipramine in a 14-year Boy

Overview

Intentional poisoning with tricyclic antidepressants (TCA) is very frequent in the population. The paper deals in detail with the case of 14-years old boy who has been treated for depressive syndrome with imipramine for a long period of time. The patient reacted to an acute stress situation by intake of a combination of drugs (imipramine at the dose of 47 mg/kg of body mass and several dragées of ibuprofen).

The severe poisoning with imipramine displayed typical dynamism of clinical manifestations, pathological changes in laboratory tests and supplementary examinations. In the course of several hours there was gradual failure of central nervous system functions, respiratory tract, cardiovascular apparatus, uropoietic tract and hemostasis. The intoxication was discovered at an early time and the complex treatment resulted in improvement of clinical condition within 35 hours, functions of the affected organs were normalized and the toxic chemicals were excreted from the organism. After 56 hours of hospitalization the boy was transferred in a stabilized condition and without neurological damage to the care of children psychiatrists.

This clinical experience has been discussed and compared with conclusions drawn in the world literature.

Key words:
intentional intoxication, tricyclic antidepressants, multi-organ failure syndrome, hemoperfusion