CONTEXT: Tricyclic antidepressive agents are widely used in suicide attempts and present a variety of deleterious effects. Rhabdomyolysis is a rare complication of such poisoning. CASE REPORT: A 55-year-old woman ingested 120 pills of 25 mg clomipramine in a suicide attempt two days before admission. After gastric lavage in another emergency department on the day of intake, 80 pills were removed. On admission to our department, she was disoriented, complaining of a dry mouth and tremors at the extremities. An electrocardiogram showed a sinus rhythm with narrow QRS complexes. Laboratory results showed high creatine phosphokinase (CK = 15,094 U/l on admission; normal range = 26 to 140 U/l), hypocalcemia, slightly increased serum transaminases and mild metabolic acidosis. The patient's medical history included depression with previous suicide attempts, obsessive-compulsive disorder, hypothyroidism and osteoporosis. She presented cardiac arrest with pulseless electric activity for seven minutes and afterwards, without sedation, showed continuous side-to-side eye movement. She developed refractory hypotension, with need for vasopressors. Ceftriaxone and clindamycin administration was started because of a hypothesis of bronchoaspiration. The patient remained unresponsive even without sedation, with continuous side-to-side eye movement and a decerebrate posture. She died two months later. Rhabdomyolysis is a very rare complication of poisoning due to tricyclic drugs. It had only previously been described after an overdose of cyclobenzaprine, which has a toxicity profile similar to tricyclic drugs. CONCLUSIONS: Although arrhythmia is the most important complication, rhabdomyolysis should be investigated in cases of clomipramine poisoning.
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机译：背景：三环类抗抑郁药广泛用于自杀尝试中，并具有多种有害作用。横纹肌溶解症是这种中毒的罕见并发症。病例报告：一名55岁的妇女在入院前两天自杀尝试中摄入了120片25毫克氯米帕明的药丸。摄入当天，在另一个急诊科洗胃后，取出了80粒药。进入我们部门后，她迷失了方向，抱怨四肢口干和震颤。心电图显示窦性心律，QRS波群狭窄。实验室结果显示肌酸磷酸激酶高（入院时CK = 15,094 U / l;正常范围= 26至140 U / l），低钙血症，血清转氨酶轻度升高和轻度代谢性酸中毒。患者的病史包括先前曾尝试过自杀的抑郁症，强迫症，甲状腺功能减退症和骨质疏松症。她进行了7分钟的无搏动电活动心脏骤停，此后没有镇静作用，表现出连续的左右眼运动。她发展为难治性低血压，需要升压药。由于支气管吸入的假设，开始使用头孢曲松和克林霉素。即使没有镇静剂，患者仍无反应，眼睛左右连续运动，并保持小脑姿势。两个月后她死了。横纹肌溶解症是由三环类药物引起的非常罕见的中毒并发症。此前仅在过量服用环苯扎林后才对其进行了描述，其毒性特征与三环类药物相似。结论：尽管心律失常是最重要的并发症，但在氯米帕明中毒的情况下应调查横纹肌溶解症。
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