All issues > Volume 51(11); 2008

Case Report

Korean J Pediatr. 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 WY Choi¹, Soo-Min SM Park¹, Ui-Jeong UJ Han¹, Young-Nam YN Kim¹, Young-Kuk YK Cho¹, Jae-Sook JS Ma¹

¹Department of pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwang-Ju, Korea

Correspondence Jae-Sook JS Ma ,Email: cardiol@jnu.ac.kr

Abstract

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.

Keywords :Tricyclic antidepressant, Imipramine, Brugada electrocardiographic pattern