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Prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report

BACKGROUND: Reduced consciousness has a wide variety of possible causes, not infrequently being toxic in nature. An intoxication might be obvious, but in this paper an unexpected case with a tricyclic antidepressant is presented. CASE PRESENTATION: A 76-year-old caucasian female was found unconsciou...

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Autores principales: van de Wint, Tijs, de Vries Schultink, Aurelia H. M., Meinders, Arend Jan, Harmsze, Ankie, Bruins, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8925239/
https://www.ncbi.nlm.nih.gov/pubmed/35296334
http://dx.doi.org/10.1186/s13256-022-03294-x
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author van de Wint, Tijs
de Vries Schultink, Aurelia H. M.
Meinders, Arend Jan
Harmsze, Ankie
Bruins, Peter
author_facet van de Wint, Tijs
de Vries Schultink, Aurelia H. M.
Meinders, Arend Jan
Harmsze, Ankie
Bruins, Peter
author_sort van de Wint, Tijs
collection PubMed
description BACKGROUND: Reduced consciousness has a wide variety of possible causes, not infrequently being toxic in nature. An intoxication might be obvious, but in this paper an unexpected case with a tricyclic antidepressant is presented. CASE PRESENTATION: A 76-year-old caucasian female was found unconscious. Primary diagnostic evaluation, including a negative drugs of abuse test, did not give direction to any clear cause. Yet an intraventricular conductive disorder with widening of the QRS complex and electroencephalogram abnormalities did suggest a possible drug effect. Heteroanamnestic information led to the suspicion of an amitriptyline intoxication, which was confirmed by further laboratory analysis. The patient remained comatose for several days. High concentrations of amitriptyline indicated a large overdose of amitriptyline and, in combination with a cytochrome P450 2D6 poor metabolizer status, could explain the long persistence of her comatose state. CONCLUSION: We present a tricyclic antidepressant intoxication, where the patient is thought to have taken a large amount of amitriptyline at once, which, in combination with a cytochrome P450 2D6 poor metabolizer status, led to an unusual long persistence of her coma.
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spelling pubmed-89252392022-03-23 Prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report van de Wint, Tijs de Vries Schultink, Aurelia H. M. Meinders, Arend Jan Harmsze, Ankie Bruins, Peter J Med Case Rep Case Report BACKGROUND: Reduced consciousness has a wide variety of possible causes, not infrequently being toxic in nature. An intoxication might be obvious, but in this paper an unexpected case with a tricyclic antidepressant is presented. CASE PRESENTATION: A 76-year-old caucasian female was found unconscious. Primary diagnostic evaluation, including a negative drugs of abuse test, did not give direction to any clear cause. Yet an intraventricular conductive disorder with widening of the QRS complex and electroencephalogram abnormalities did suggest a possible drug effect. Heteroanamnestic information led to the suspicion of an amitriptyline intoxication, which was confirmed by further laboratory analysis. The patient remained comatose for several days. High concentrations of amitriptyline indicated a large overdose of amitriptyline and, in combination with a cytochrome P450 2D6 poor metabolizer status, could explain the long persistence of her comatose state. CONCLUSION: We present a tricyclic antidepressant intoxication, where the patient is thought to have taken a large amount of amitriptyline at once, which, in combination with a cytochrome P450 2D6 poor metabolizer status, led to an unusual long persistence of her coma. BioMed Central 2022-03-16 /pmc/articles/PMC8925239/ /pubmed/35296334 http://dx.doi.org/10.1186/s13256-022-03294-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
van de Wint, Tijs
de Vries Schultink, Aurelia H. M.
Meinders, Arend Jan
Harmsze, Ankie
Bruins, Peter
Prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report
title Prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report
title_full Prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report
title_fullStr Prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report
title_full_unstemmed Prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report
title_short Prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report
title_sort prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8925239/
https://www.ncbi.nlm.nih.gov/pubmed/35296334
http://dx.doi.org/10.1186/s13256-022-03294-x
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