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A case of imipramine induced toxicity with Brugada electrocardiographic pattern in a toddler

Korean Journal of Pediatrics 2008;51(11):1232-1235.
Published online November 15, 2008.
A case of imipramine induced toxicity with Brugada electrocardiographic pattern in a toddler
Woo-Yeon Choi, Soo-Min Park, Ui-Jeong Han, Young-Nam Kim, Young-Kuk Cho, Jae-Sook Ma
Department of pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwang-Ju, Korea
Brugada 심전도 양상을 포함한 이미프라민에 의한 독성 부작용 1예
최우연, 박수민, 한의정, 김영남, 조영국, 마재숙
전남대학교 의과대학 전남대학교병원 소아과학교실
Jae-Sook Ma, Email: cardiol@jnu.ac.kr
Imipramine, a tricyclic antidepressant (TCA), is used for the treatment of non-polar depression and nocturnal enuresis in children in whom an organic pathology has been excluded, anxiety disorders, and neuropathic pain. Clinical toxicity following the treatment of TCAs, including imipramine, is well known. The anticholinergic effects initially present include a dry mouth, ileus, dilated pupils, urinary retention, and mild sinus tachycardia. The central nervous system toxicity includes delirium, agitation, restlessness, hallucinations, convulsions, and CNS depression or coma. However, the most life-threatening toxicity remains the development of cardiac dysrhythmias. Conduction delays such as QRS and corrected QT prolongation, wide QRS complex tachycardia, and the Brugada electrocardiographic pattern have been reported. Sodium bicarbonate decreases QRS widening and suppresses dysrhythmias by providing excess sodium to reverse the TCA-induced sodium-channel blockade and possibly by binding directly to the myocardium. There are no pediatric case reports on imipramine or other TCA associated toxicity in Korea. Here, we describe a patient who presented with convulsions, tachycardia with a wide QRS complex, a Brugada electrocardiographic pattern, and anuresis associated with an accidental overdose of imipramine and the outcome of treatment with sodium bicarbonate.
Key Words: Tricyclic antidepressant, Imipramine, Brugada electrocardiographic pattern

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