Hemodiafiltration: A novel approach for treating severe amitriptyline intoxication

Abstract

Tricyclic antidepressant overdose is one of the most common cause of serious drug poisonings. Sometimes amitriptyline intoxication can be difficult to treat with standard treatments. At that case hemodiafiltration (HD) can be an eligible choice. We report a successful treatment of severe case using hemodiafiltration in addition to the supportive measures. Management with gastric lavage, activated charcoal, alkalinization and supportive care is the common approach and not enough for patients in deep coma. We satisfied that HD may have a beneficial role in lethal doses of amitriptyline as an additional therapy.

Treatment of amitriptyline intoxications by extended high cut-off dialysis

“…The potential benefit of modern means of renal replacement therapy was suggested in a report on haemodiafiltration after acute amitriptyline intoxication in which the patient showed an improved vigilance during treatment. As no amitriptyline blood concentrations were reported, establishing causality for clinical improvement is difficult [ 14 ]. Recently, extended dialysis using an HCO dialyser has been introduced to remove large quantities of free light chains in patients with multiple myeloma [ 11 ].…”