Tricyclic Antidepressant Toxicity in Pediatrics Follow-up

Updated: Apr 22, 2016
  • Author: Derrick Lung, MD, MPH; Chief Editor: Timothy E Corden, MD  more...
  • Print
Follow-up

Further Outpatient Care

Patients may be discharged from the emergency department (ED) if the ingestion was unintentional, if no signs or symptoms of cyclic antidepressant toxicity are evident during a minimum observation of 6-8 hours, if the parents are reliable, and if appropriate follow-up is assured.

Next:

Further Inpatient Care

Patients with severe CNS toxicity or any cardiotoxicity should be admitted to an ICU setting. Patients should be monitored for at least 24 hours after the ECG findings normalize and alkalinization therapy is stopped.

All patients with suspected or confirmed cyclic antidepressant (CA) overdose should be admitted for cardiac monitoring for at least 12-24 hours. Patients may be admitted to a non-ICU ward for telemetry monitoring if they have persistent signs of mild-to-moderate anticholinergic toxicity (ie, resting tachycardia, mydriasis, behavioral changes, hyperthermia) without serious CNS or cardiac manifestations.

Patients with suspected overdose should be screened for suicidal behavior and admitted to a psychiatric facility, if indicated, once they are medically cleared.

Children with unintentional overdose should be admitted if inadequate supervision in the home is suspected or if adequate follow-up cannot be assured.

Previous
Next:

Transfer

All serious pediatric cyclic antidepressant overdoses should be admitted to a pediatric ICU. Transfer may be indicated after the patient has been stabilized if the treating hospital has no such facility.

Previous
Next:

Deterrence/Prevention

Prevention remains the first line of defense against all pediatric ingestions. Important prevention measures include the following:

  • Child-resistant packaging of all medications
  • Proper storage of medications in the home
  • Education of parents and children as to the risks and proper use of medications
  • Easy access to poison control center information
Previous
Next:

Prognosis

Approximately 70% of intentional cyclic antidepressant overdoses may be fatal prior to arrival in the ED. However, among patients who present for medical treatment, serious complications are rare compared with the total number of toxic ingestions, and in-hospital mortality is as low as 2-3%. With early recognition and aggressive treatment, a good outcome can be expected.

Previous
Next:

Patient Education

Previous