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Related Experiment Videos

Tricyclic antidepressant poisoning.

J Glauser1

  • 1Department of Emergency Medicine, Cleveland Clinic, USA. glausej@ccf.org

Cleveland Clinic Journal of Medicine
|November 4, 2000
PubMed
Summary
This summary is machine-generated.

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Tricyclic antidepressant poisoning can be lethal, causing heart problems and seizures. Sodium bicarbonate is the preferred treatment for severe toxicity, especially when QRS duration exceeds 100 ms.

Area of Science:

  • Toxicology
  • Cardiology
  • Emergency Medicine

Background:

  • Tricyclic antidepressants (TCAs) are widely prescribed for depression, chronic pain, and various psychiatric disorders.
  • TCA poisoning presents with significant morbidity and mortality, primarily due to cardiovascular and neurological toxicity.
  • Predicting severe complications is crucial for timely and effective management.

Observation:

  • Electrocardiographic abnormalities, including a QRS interval longer than 100 ms, are common in TCA poisoning.
  • Cardiovascular manifestations include arrhythmias, hypotension, heart block, bradyarrhythmias, and asystole.
  • Elevated serum TCA levels are less reliable predictors of serious complications than QRS duration.

Findings:

  • Sodium bicarbonate is the treatment of choice for severe TCA toxicity, particularly when QRS duration exceeds 100 ms or terminal right-axis deviation is >120 degrees.

Related Experiment Videos

  • Activated charcoal can be used for decontamination, with or without a cathartic.
  • Hypertonic saline is a potential alternative treatment for severe toxicity.

    • Implications:

    • Early recognition of ECG changes, specifically QRS duration, is vital for guiding treatment decisions in TCA poisoning.
    • Prompt administration of sodium bicarbonate can mitigate life-threatening cardiovascular complications.
    • This highlights the importance of ECG monitoring in the management of tricyclic antidepressant overdose.