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Published on: May 28, 2019
Prolonged use of intravenous lipid emulsion in a severe tricyclic antidepressant overdose
Ravi Agarwala1, Syed Zaki Ahmed, Timothy J Wiegand
1Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA, ragarwal@wakehealth.edu.
Introduction:
Intravenous lipid emulsion (ILE) resuscitation is now frequently being used for severe overdoses due to lipophilic drugs. However, the optimal dose, duration, and safety are still unclear.
Case Report:
A patient with refractory cardiovascular collapse following an amitriptyline overdose was treated with ILE with initial improvement. Instability recurred after ILE discontinuation and lipid therapy was restarted, but high-dose treatment was complicated by severe lipemia. A low-dose infusion was instead used, and the patient did not experience further toxicity despite amitriptyline levels in the toxic range for 21 days. He survived to discharge without long-term sequelae.
Discussion:
A low-dose infusion of ILE was well tolerated and may have successfully prevented recurrent toxicity in a case of severe tricyclic antidepressant overdose.
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