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Plasma alkalinization for tricyclic antidepressant toxicity: a systematic review
K Blackman1, S G Brown, G J Wilkes
1Department of Emergency Medicine, Royal Hobart Hospital, Hobart Tasmania, Australia. Konrad.Blackman@dchs.tas.gov.au
Emergency Medicine (Fremantle, W.A.)
|August 3, 2001
Summary
Plasma alkalinization for tricyclic antidepressant toxicity is primarily supported by animal studies and case reports. While potentially beneficial for severe cases, evidence does not support its routine prophylactic use.
Area of Science:
- Toxicology
- Emergency Medicine
- Pharmacology
Background:
- Tricyclic antidepressant (TCA) overdose is a significant cause of morbidity and mortality.
- Plasma alkalinization is a proposed treatment to improve outcomes in TCA toxicity.
Purpose of the Study:
- To review existing evidence on the efficacy of plasma alkalinization in treating tricyclic antidepressant toxicity.
- To assess the scientific basis for using alkalinization in TCA overdose management.
Main Methods:
- Comprehensive literature search of Medline (1966-2000) and bibliographies.
- Inclusion of all study types: animal, in vitro, case reports, case series, and retrospective studies.
- Analysis of 115 retrieved publications, including 12 animal studies and limited human data (no RCTs).
Main Results:
- Evidence for plasma alkalinization in TCA toxicity is derived from animal studies, case reports, and expert opinion.
- No randomized controlled trials in humans were identified.
- Animal studies suggest pH manipulation affects physiological parameters in TCA toxicity, but interspecies variation complicates human extrapolation.
Conclusions:
- The mechanism of alkalinization in TCA toxicity is multifaceted and may differ between TCAs.
- Alkalinization may be reasonable for patients with life-threatening dysrhythmias or shock unresponsive to supportive care.
- Prophylactic alkalinization is not supported by current evidence in the absence of severe cardiovascular toxicity.