%0 Journal Article
%T Heart Rate Variability in Children with Tricyclic Antidepressant Intoxication
%A Ener Cagri Dinleyici
%A Zubeyir Kilic
%A Sabiha Sahin
%A Rabia Tutuncu-Toker
%A Makbule Eren
%A Zeynel Abidin Yargic
%A Pelin Kosger
%A Birsen Ucar
%J Cardiology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/196506
%X The aim of this study was to evaluate HRV in children requiring intensive care unit stays due to TCA poisoning between March 2009 and July 2010. In the time-domain nonspectral evaluation, the SDNN ( ), SDNNi ( ), RMSDD ( ), and pNN50 ( ) were found to be significantly lower in the TCA intoxication group. The spectral analysis of the data recorded during the first 5 minutes after intensive care unit admission showed that the values of the nLF ( ) and the LF/HF ratio ( ) were significantly higher in the TCA intoxication group, while the nHF ( ) values were significantly lower. The frequency-domain spectral analysis of the data recorded during the last 5 minutes showed a lower nHF ( ) in the TCA intoxication group than in the controls, and the LF/HF ratio was significantly higher ( ) in the intoxication group. The LF/HF ratio was higher in the seven children with seizures ( ). These findings provided us with a starting point for the value of HRV analysis in determining the risk of arrhythmia and convulsion in TCA poisoning patients. HRV can be used as a noninvasive testing method in determining the treatment and prognosis of TCA poisoning patients. 1. Introduction Poisoning is a common and important cause of morbidity and mortality worldwide, especially during childhood. More than 50% of patients reported to poison control centers are adolescents or less than five years of age [1]. Among the substances that cause poisoning, drugs have been reported as the most common factor. In Turkey, tricyclic antidepressants (TCA) occupy an important place among the causes of poisoning, and the incidence of such events has increased over the last decade [2]. TCAs (amitriptyline, nortriptyline, clomipramine, desipramine, imipramine, doxepinm, and protriptyline) are frequently used for the treatment of depression, chronic pain syndrome, school phobia, hyperkinesias, nocturnal enuresis, and attention deficit-hyperactivity disorder [3]. TCA-related poisoning influences the autonomic nervous system, central nervous system (CNS), and cardiovascular system (CVS), and clinical signs appear within 6¨C8 hours. There is no laboratory test to precisely diagnose TCA-related poisoning, and it is impossible to predict the prognosis. The semiquantitative enzyme immunoassay technique may be useful for measuring TCA levels; however, there is no correlation between drug levels and clinical findings [4]. The most severe life-threatening condition in TCA-related poisoning is the dysrhythmias that occur due to the quinidine-like effects on the myocardial tissue. Electrocardiogram (ECG)
%U http://www.hindawi.com/journals/crp/2013/196506/