To the Editor: In the article, "Amitriptyline Poisoning" by P. Sunshine and S. J. Yaffe, (Amer J Dis Child 106:501, 1963) is reported a 15-month-old girl, who had ingested 1,000-1,125 mg of amitriptyline HCL. On admission, she was alert and in no distress. Approximately 80-85 minutes after ingestion, a gastric lavage was performed with 2,000 cc of distilled water. Five to ten minutes later she suddenly got ill with typical symptoms of water intoxication.
There is only a vague remark that all the wash water was returned,—opposite to the exact stated amount of given water—which in this case causes a suspicion of two possible poisons: amitriptyline and water!
The effect of amitriptyline is suggested to be sensitizing the central nervous system for adrenergic substances, especially levarterenol (norepinephrin). Amitriptyline has a strong anticonvulsive effect.9 The median lethal dose in adult mice is 280 mg/kg orally and 28 mg/kg intravenously, as
KOLLBERG H. A THERAPEUTIC APPROACH MORE POISONING THAN POISON ITSELF?. Am J Dis Child. 1964;107(5):535-536. doi:10.1001/archpedi.1964.02080060537018