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Hyperthermia complicating tricyclic antidepressant overdose

P Hantson1, M Benaissa, J L Clemessy

  • 1Réanimation Toxicologique, Hôpital Fernand Widal, Paris, France.

Intensive Care Medicine
|May 1, 1996
PubMed
Summary

Severe amitriptyline overdose caused refractory hyperpyrexia in a patient, leading to death despite aggressive cooling and medical treatments. This case highlights the critical dangers of tricyclic antidepressant toxicity.

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Area of Science:

  • Toxicology
  • Cardiology
  • Critical Care Medicine

Background:

  • Amitriptyline is a tricyclic antidepressant with known cardiovascular and neurological side effects.
  • Severe overdose can lead to life-threatening complications, including hyperthermia and cardiac arrhythmias.

Observation:

  • A 51-year-old woman presented with severe amitriptyline overdose.
  • She developed refractory hyperpyrexia, with central body temperature exceeding 43°C for 5 hours.
  • Cardiovascular complications, including collapse and arrhythmias, were also noted.

Findings:

  • The patient's hyperthermia was unresponsive to standard cooling measures (ice water, gastric lavage) and specific medications (dantrolene, bromocriptine).
  • The patient ultimately died from cardiocirculatory collapse and arrhythmias on day 3.

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Implications:

  • This case underscores the potential for extreme and refractory hyperthermia in severe amitriptyline overdose.
  • It highlights the limitations of current treatment modalities for such severe toxicological emergencies.
  • Further research into the mechanisms and management of refractory hyperthermia in overdose settings is warranted.