[Poisoning due to tricyclic antidepressants in children and adolescents]. / L'intoxication par antidépresseurs tricycliques chez l'enfant et l'adolescent.

During the last decade there has been a substantial increase in the number of poisonings due to tricyclic antidepressants in both children and adults. The main toxic manifestations are of anticholinergic origin, and the most frequent constitute the so-called central anticholinergic syndrome. Most of the deaths result from the cardiac complications. Three cases are presented that illustrate chiefly the toxic manifestations related to the central nervous system. The therapeutic management is reviewed in the light of the metabolism of the tricyclic antidepressants, their pharmacologic action and the mechanism of their toxic effects.

Diabetes mellitus in gonadal dysgenesis: studies of insulin and growth hormone secretion.

On the basis of results obtained from an oral glucose tolerance test, (OGTT), twenty patients with gonadal dysgenesis were classified as normal (N = 8) and diabetic (N = 12). The two groups of patients were further tested by a rapid intravenous glucose injection, a tolbutamide test, an insulin sensitivity test and an oral amino acid load. Fasting levels of plasma growth hormone (GH) were normal in all subjects but one. Approximately 1/3 of the GH responses during testing periods were abnormal, being either absent during hypoglycaemia or following amino acid ingestion, or paradoxically increased during hyperglycaemia. No correlation was found between the degree of carbohydrate intolerance and the levels of plasma GH. There was no gross alteration of tissue sensitivity to exogenous insulin. The beta-cell response to tolbutamide, amino acid and intravenous glucose were comparable in patients with a normal or a diabetic OGTT. In both groups, the rates of decrease of blood glucose following tolbutamide or intravenous glucose were also similar and within the normal range. During OGTT, the diabetic group had a delayed insulin release and a low insulinogenic index. It is concluded that in gonadal dysgenesis the intolerance to an oral carbohydrate load is frequently associated with, but unrelated to, anomalies of the GH secretion. In diabetic subjects, the process of insulin secretion loses its normal sensitivity to the oral glucose stimulus while remaining unaltered and similiar to that of non-diabetic subjects in response to tolbutamide, amino acid and intravenous glucose.