Hemodiafiltration Practice in a Patient with Severe Amitriptyline Intoxication

Abstract

Tricyclic antidepressants are widely used drugs for treatment of depression despite serious mortality and morbidity in higher doses. They can cause severe cardiac arrhythmias, hypotension and central nervous system depression. Some patients may remain unresponsive in spite of conventional therapies such as gastric lavage and activated charcoal administration, benzodiazepines, volume replacement, lidocaine and sodium bicarbonate infusion. In this paper we report a 20-year-old female patient who had severe amitriptyline intoxication with a Glasgow Coma Scale score 4 and severe cardiac arrhythmias and was treated with hemodiafiltration. Conventional therapy was inadequate and hemodiafiltration was applied to the patient for 36 hours. At the end of the 36-hours the patient was conscious and became stabilized in terms of hemodynamics. In case of serious intoxication that does not respond to conventional therapy, approaches like hemodialysis, plasmapheresis, hemoperfusion and hemodiafiltration can be a rescue therapy and they should be considered.