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Adverse cardiac events in ICU patients with presumptive antidepressant overdose
C A Arranto1, C Mueller, P R Hunziker
1Division of Intensive Care, Basel University Hospital, Switzerland. Christian.Arranto@stud.unibas.ch
Insights
Antidepressant overdose patients frequently have mixed drug ingestions. Adverse cardiac events can occur even with normal initial ECGs, highlighting the need for careful monitoring in intensive care units.
Area of Science:
- Emergency Medicine
- Clinical Toxicology
- Cardiology
Background:
- Antidepressants are a leading cause of poison-related intensive care unit admissions.
- Previous studies suggested normal QRS intervals (<0.1s) on ECGs within six hours could rule out cardiac events in cyclic antidepressant intoxication.
- Prospective data on cardiac events and ECG criteria in presumed antidepressant overdose are limited.
Purpose of the Study:
- To evaluate ingested substances, cardiac events, and electrocardiogram (ECG) findings in intensive care unit (ICU) patients with suspected antidepressant overdose.
- To assess the predictive value of ECG criteria in this patient population.
Main Methods:
- Prospective enrollment and follow-up of 103 consecutive ICU patients with a presumptive diagnosis of antidepressant overdose.
- Monitoring for arrhythmias, mortality, and ICU length of stay.
- Analysis of ingested drugs and ECG parameters, including QRS interval.
Main Results:
- Mixed drug intoxication was prevalent, found in 64% of patients.
- Tricyclic antidepressants (85%) and serotonin-reuptake inhibitors (24%) were common.
- 15% of patients experienced arrhythmias, and 3% died. Adverse cardiac events occurred in patients with both normal and prolonged QRS intervals at presentation.
Conclusions:
- Most ICU patients with suspected antidepressant overdose present with mixed ingestions.
- There is a significant risk of adverse cardiac events, irrespective of initial ECG findings within the first six hours.
- Standard ECG criteria may not reliably exclude cardiac complications in all cases of antidepressant overdose.
Background:
Antidepressants account for most poison-related admissions to intensive care units. In selected patients with confirmed cyclic antidepressant intoxication a QRS interval <0.1 s in the ECG limb leads during the first six hours excludes adverse cardiac events. However, the incidence of cardiac events and the value of ECG criteria have never been assessed prospectively on patients with presumed antidepressant overdose.
Aim:
To assess ingested drugs, adverse cardiac events, and ECG findings in ICU patients with a presumptive diagnosis of antidepressant overdose.
Methods:
103 consecutive patients with a presumptive diagnosis of antidepressant overdose were enrolled and prospectively followed. Outcome criteria were arrhythmias, mortality, and duration of the ICU stay.
Results:
Mixed intoxication was identified in 66 (64%) patients. Tricyclic antidepressants were found in 88 (85%), and serotonin-reuptake inhibitors in 25 (24%) patients. Mean APACHE II score was 9.5 (SD +/- 6.0). Arrhythmias affected 15 (15%) and cardiopulmonary resuscitation was performed on 4 (4%) patients. Three patients (3%) died in the ICU. Median duration of the ICU stay was 1 day (12 hours to 6 days). Adverse cardiac events affected patients with normal and prolonged QRS interval at study entry.
Conclusions:
Mixed intoxication is present in most ICU patients with suspected antidepressant overdose. There is a considerable risk for adverse cardiac events, even in the presence of normal ECG recordings within the first six hours after hospital admission.
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