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

Brugada 심전도 양상을 포함한 이미프라민에 의한 독성 부작용 1예

  • Choi, Woo-Yeon (Department of pediatrics, Chonnam National University Medical School Chonnam National University Hospital) ;
  • Park, Soo-Min (Department of pediatrics, Chonnam National University Medical School Chonnam National University Hospital) ;
  • Han, Ui-Jeong (Department of pediatrics, Chonnam National University Medical School Chonnam National University Hospital) ;
  • Kim, Young-Nam (Department of pediatrics, Chonnam National University Medical School Chonnam National University Hospital) ;
  • Cho, Young-Kuk (Department of pediatrics, Chonnam National University Medical School Chonnam National University Hospital) ;
  • Ma, Jae-Sook (Department of pediatrics, Chonnam National University Medical School Chonnam National University Hospital)
  • 최우연 (전남대학교 의과대학, 전남대학교병원 소아과학교실) ;
  • 박수민 (전남대학교 의과대학, 전남대학교병원 소아과학교실) ;
  • 한의정 (전남대학교 의과대학, 전남대학교병원 소아과학교실) ;
  • 김영남 (전남대학교 의과대학, 전남대학교병원 소아과학교실) ;
  • 조영국 (전남대학교 의과대학, 전남대학교병원 소아과학교실) ;
  • 마재숙 (전남대학교 의과대학, 전남대학교병원 소아과학교실)
  • Received : 2008.06.04
  • Accepted : 2008.09.04
  • Published : 2008.11.15

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.

삼환계 항우울제의 하나인 이미프라민은 우울장애와 야뇨증, 불안장애, 신경성 통증에 쓰인다. 그러나 이미프라민을 포함한 삼환계 항우울제는 많은 부작용이 관찰되는 데, 항콜린성 작용으로 초기에 입이 마르고 동공산대, 소변 정체, 동성빈맥을 보인다. 또한 중추신경계에 작용하여 섬망, 불안, 초조, 환각, 경련, 혼수를 야기할 수 있다. 그러나 앞에서 말한 부작용 보다도 치명적인 것인 삼환계 항우울제에 의해 소디움 채널 차단으로 인한 부정맥이다. QRS파의 연장과 QTc 연장, 넓은 QRS파 빈맥, Brugada 심전도 양상이 나타나며 이런 현상은 중탄산 나트륨을 통해 나트륨을 대량으로 공급하여 회복시킬 수 있다. 이미프라민을 포함한 삼환계 항우울제에는 아직도 널리 쓰이고 있지만 지금까지 소아에서 부정맥이 부작용으로 나타난 증례에 대한 보고가 없었다. 따라서 저자들은 이미프라민 과량복용 후 경련, 넓은 QRS파를 보이는 빈맥, Brugada 심전도 양상, 무뇨를 보인 환아를 경험, 치료하여 이를 보고한다.

Keywords

References

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