Use of dosage as a triage guideline for unintentional cyclic antidepressant (UCA) ingestions in children

Triage guidelines for unintentional cyclic antidepressant (UCA) ingestions vary widely, with limited supportive evidence. All records of UCA ingestion reported to 4 certified regional poison centers were evaluated for the years 1998 through 2000. Inclusion criteria included age ≤6 years patients with a known outcome and known ingested dose by history. Exclusion criterion was polydrug ingestion. Two hundred forty-six cases were evaluated. The mean age was 2.4 years (standard deviation, ±1.2 y). One hundred thirty-six patients (55%) were managed in a hospital. One hundred ten patients were managed at home with observation and telephone follow up. Symptoms reported were drowsiness (n = 59), tachycardia (n = 4), agitation (n = 2), coma (n = 2), respiratory depression (n = 1), and ataxia (n = 1). Medical outcome was reported as no effect (n = 185; 75%), minor effect (n = 57; 23%), moderate effect (n = 2; 1%); and major effect (n = 2; 1%). Mean dosage of patients with and without symptoms was 6.3 mg/kg (± 9.3) and 2.9 mg/kg (± 3.1), respectively. Forty-three of 57 patients (75%) with minor symptoms reported a dosage of <5 mg/kg. All patients with a moderate or major outcome (n = 4) reported a dosage of >5 mg/kg. The majority of UCA ingestions produced limited or no symptomatology. In this series, all children with ingestions of <5 mg/kg developed no or minor effects. Home monitoring might be appropriate in such cases.