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Tricyclic antidepressant poisoning.

L J Dziukas1, J Vohra

  • 1Emergency Department, Alfred Hospital, Prahran, VIC.

The Medical Journal of Australia
|March 4, 1991
PubMed
Summary
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Tricyclic antidepressant overdose is characterized by neurological and cardiac effects. Prompt gastric emptying and activated charcoal are crucial, with specific treatments for cardiotoxicity and arrhythmias.

Area of Science:

  • Toxicology
  • Emergency Medicine
  • Pharmacology

Background:

  • Tricyclic antidepressants (TCAs) are commonly prescribed for depression and other conditions.
  • Overdose of TCAs can lead to serious and life-threatening complications.

Purpose of the Study:

  • To review the clinical features, management, and outcomes of tricyclic antidepressant poisoning.
  • To identify key interventions for improving patient survival and outcomes.

Main Methods:

  • Comprehensive literature search of English language articles from 1977-1989.
  • Analysis of approximately 250 selected articles, abstracts, and book chapters.
  • Focus on 93 representative articles detailing important advances in TCA overdose management.

Related Experiment Videos

Main Results:

  • Major overdose features include neurological, cardiac, respiratory, and anticholinergic symptoms.
  • Life-threatening complications typically manifest within six hours of ingestion.
  • Recommended interventions include gastric emptying, activated charcoal, and standard resuscitation.
  • Alkalinization with sodium bicarbonate or hyperventilation is indicated for cardiotoxicity, targeting pH 7.45-7.55.
  • Lignocaine is the preferred agent for ventricular arrhythmias; other antiarrhythmics are contraindicated or unproven.
  • Physostigmine, hemodialysis, and hemoperfusion are not beneficial.

Conclusions:

  • The mortality rate for patients reaching the hospital is 2-3%.
  • Cardiac dysfunction, primarily myocardial depression, is the leading cause of death, rather than arrhythmias.