Response to glucagon in imipramine overdose

Area of Science:

• Cardiology
• Toxicology
• Pharmacology

Background:

• Tricyclic antidepressant (TCA) overdose can cause life-threatening hypotension and cardiac arrhythmias.
• Standard treatments for TCA-induced hypotension are often ineffective.
• Intravenous glucagon has shown potential in managing certain drug-induced cardiovascular toxicities.

Observation:

• A 25-year-old woman presented with severe hypotension following a massive imipramine overdose.
• Electrocardiogram (ECG) revealed significant QRS widening (129 msec).
• The patient received intravenous glucagon (10 mg bolus followed by 10 mg over 6 hours).

Findings:

• Intravenous glucagon administration resulted in an immediate and sustained increase in blood pressure.
• The QRS interval on the ECG significantly shortened from 129 msec to 89 msec.
• The patient's hemodynamic status improved following glucagon treatment.

Implications:

• Glucagon should be strongly considered as a treatment for hypotension associated with tricyclic antidepressant overdose.
• Glucagon may possess antiarrhythmic properties beneficial in managing TCA cardiotoxicity.
• This case highlights the potential of glucagon as a life-saving intervention in severe TCA poisoning.