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"Lipid rescue" for tricyclic antidepressant cardiotoxicity
Michael Stephen Blaber1, Jamal Nasir Khan, Judith Anne Brebner
1Department of Cardiology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK.
Background:
Tricyclic antidepressant (TCA) toxicity results predominantly from myocardial sodium-channel blockade. Subsequent ventricular dysrhythmias, myocardial depression, and hypotension cause cardiovascular collapse. Animal studies have demonstrated the effectiveness of intravenous lipid-emulsion in treating TCA cardiotoxicity.
Case Report:
We report a case of dothiepin (tricyclic antidepressant) overdose causing refractory cardiovascular collapse, which seemed to be successfully reversed with lipid-emulsion therapy (Intralipid(®); Fresenius, Cheshire, UK).
Conclusions:
Lipid emulsions are a potentially novel therapy for reversing cardiotoxicity seen in TCA overdose. Research is required into the role of lipid emulsion in the management of poisoning by oral lipophilic agents.
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