Coma with ECG abnormalities: Consider tricyclic antidepressant intoxication

Netherlands Journal of Medicine

Volumn 65, Issue 4, 2007, Pages 142-146

  Veris van Dieren, J ^a   Valk, L ^a   Van Geijlswijk, I ^a   Tjan, D ^a   Van Zanten, A ^a  

^a GELDERSE VALLEI HOSPITAL   (Netherlands)

Author keywords

Cardiogenic shock; Coma; ECG abnormalities; Intoxication; Tricyclic antidepressant poisoning

Indexed keywords

ADRENALIN; ATENOLOL; BENZODIAZEPINE DERIVATIVE; CALCIUM; CLONAZEPAM; CODEINE PHOSPHATE; DOBUTAMINE; DOPAMINE; FLUMAZENIL; HYDROCHLOROTHIAZIDE; IRBESARTAN; LITHIUM; MIDAZOLAM; NORADRENALIN; NORTRIPTYLINE; OLANZAPINE; OXAZEPAM; PAROXETINE; PROPRANOLOL; TEMAZEPAM; TRICYCLIC ANTIDEPRESSANT AGENT; VALPROIC ACID;

ACUTE KIDNEY TUBULE NECROSIS; ADULT; AGED; ARTICLE; ATRIOVENTRICULAR BLOCK; BIPOLAR DISORDER; BRADYCARDIA; BRAIN CONCUSSION; BRAIN CONTUSION; CASE REPORT; CEREBROSPINAL FLUID ANALYSIS; CLINICAL FEATURE; COMA; COMPUTER ASSISTED TOMOGRAPHY; DRUG BLOOD LEVEL; DRUG INTOXICATION; DRUG MEGADOSE; DRUG OVERDOSE; DRUG SAFETY; ECG ABNORMALITY; ELECTROCARDIOGRAPHY; FEMALE; HEART INFARCTION; HEART LEFT ANTERIOR BUNDLE BRANCH BLOCK; HEART RIGHT BUNDLE BRANCH BLOCK; HUMAN; HYPERTENSION; HYPOTENSION; HYPOTHYROIDISM; INTENSIVE CARE; KIDNEY FAILURE; LABORATORY TEST; LIVER FUNCTION TEST; LUNG INFILTRATE; MATERNAL HYPERTENSION; PATIENT ASSESSMENT; PNEUMONIA; RESPIRATORY FAILURE; THORAX RADIOGRAPHY; TONIC CLONIC SEIZURE; TREATMENT DURATION; TREATMENT OUTCOME;

ADULT; AGED; ANTIDEPRESSIVE AGENTS, TRICYCLIC; ARRHYTHMIA; COMA; DIAGNOSIS, DIFFERENTIAL; ELECTROCARDIOGRAPHY; EMERGENCY TREATMENT; FEMALE; HUMANS; MEDICAL HISTORY TAKING; OVERDOSE; SHOCK, CARDIOGENIC; SUICIDE, ATTEMPTED;

EID: 34247495052     PISSN: 03002977     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (27)

1. Thanacoody HKR, Thomas SHL. Antidepressant poisoning. Clin Med 2003;3:114-8.
2. Kerr GW, McGuffie AC, Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J 2001;18:236-41.
3. Henry JA, Alexander CA, Sener EK Relative mortality from overdose of antidepressants. BMJ 1995;310:221-4.
4. Power BM, Hackett LP, Dusci LJ, Ilett KF. Antidepressant toxicity and the need for identification and concentration monitoring in overdose. Clin Pharmacokinet 1995;29:154-71.
5. Jick SS, Dean AD, Jick H. Antidepressants and suicide. BMJ 1995;310:215-8.
6. Ujheli MR. Assessment of tricyclic antidepressant toxicity: Looking for a needle in a pharmacologic haystack. Crit Care Med 25;10:1634-6.
7. Hantson P, Benaissa M, Clemessy JL, Baud FJ. Hyperthermia complicating tricyclic antidepressant overdose. Intensive Care Med 1996;22:453-5.
8. Buckley NA, Chevalier S, Leditschke IA, O'Connel DL, Leitch J, Pond SM. The limited utility of electrocardiography variables used to predict arrhythmia in psychotropic drug overdose. Crit Care 2003;7:101-7.
9. Pimentel L, Trommer L. Cyclic antidepressant overdoses, a review. Emerg Med Clin North America 1994;12:533-47.
10. Harrigan RA, Brady WJ. ECG abnormalities in tricyclic antidepressant ingestion. Am J Emerg Med 1999;17:387-93.
11. Thanacoody HKR, Thomas SHL. Antidepressant poisoning. Clin Med 2003;3:114-8.
12. Dahlin KL, Lastbom L, Blomgren B, Ryrfeldt A. Acute lung failure induced by tricyclic antidepressants. Toxicol Appl Pharmacol 1997;146:309-16.
13. Zuckerman GB, Conway EE. Pulmonary complications following tricyclic antidepressant overdose in an adolescent. Ann Pharmacotherapy 1993;27:572-4.
14. Kerr GW, McGuffie AC, Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J 2001;18:236-41.
15. Amitai Y, Erickson T, Kennedy EJ, et al. Tricyclic antidepressants in red cells and plasma: correlation with impaired intraventricular conduction in acute overdose. Clin Pharmacol Ther 1993;54(2):219-27.
16. Fu C, Katzman M, Goldbloom D. Valproate/nortriptyline interaction. J Clin Psychopharmacol 1994;14:205-6.
17. Ereshefsky L, Riesenman C, Lam YW. Antidepressant drug interactions and the cytochrome P450 system. The role of cytochrome P450 2D6. Clin Pharmacokinet 1995;29 Suppl 1:10-8.
18. Newton EH, Shih RD, Hoffman RS. Cyclic antidepressant overdose: a review of current management strategies. Am J Emerg Med 1994;12:376-9.
19. Lavoie FW, Gansert GG, Weiss RE. Value of initial ECG findings and plasma drug levels in cyclic antidepressant overdose. Ann Emerg Med 1990;19:696-700.
20. Liebelt EL, Ulrich A, Francis P, Woolf A. Serial electrocardiogram changes in acute tricyclic antidepressant overdoses. Crit Care Med 1997;25:1721-6.
21. Rechlin T. Decreased R-R variation: a criterion for overdosage of tricyclic psychotropic drugs. Int Care Med 1995;21:598-601.
22. Liebelt EL, Francis PD, Woolf AD. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Ann Emerg Med 1995;26:195-201.
23. Niemann JT, Bessen HA, Rothstein RJ, Laks MM. Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity. Am J Cardiol 1986;57:1154-9.
24. Pentel PR, Benowitz NL. Tricyclic antidepressant poisoning. Management of arrhythmias. Med Toxicol 1986;1:101-21.
25. McCabe JL, Cobaugh DJ, Menegazzi JJ, Fata J. Experimental tricyclic antidepressant toxicity: a randomized, controlled comparison of hypertonic saline solution, sodium bicarbonate, and hyperventilation. Ann Emerg Med 1998;32:329-33.
26. Karkkainen S, Neuvonen PJ. Pharmacokinetics of amitriptyline influenced by oral charcoal and urine pH. Int J Clin Pharmacol Ther Toxicol 1986;24:326-32.
27. Wrenn K, Smith BA, Slovis CM. Profound alkalemia during treatment of tricyclic antidepressant overdose: a potential hazard of combined hyperventilation and intravenous bicarbonate. Am J Emerg Med 1992;10:553-5.