Abstract
We report a case of profound neurologic and cardiovascular manifestations of tricyclic antidepressant intoxication following self-poisoning with multiple pharmaceuticals including amitriptyline in excess of 43 mg/kg, in a 51-year-old male. Institution of mechanical ventilation, volume expansion, systemic alkalinisation (pH 7.51), and intermittent bolus metaraminol resulted in QRS narrowing but failed to resolve the developed shock. One 100-ml bolus of 20% lipid emulsion followed by a further 400 ml over 30 min was administered with restoration of haemodynamic stability, thereby curtailing the need for ongoing vasopressor medications. Assayed blood levels were consistent with the 'lipid sink' being a major effecter in the observed improvement.
Highlights
Therapeutic use of intravenous lipid emulsion (ILE) in the arrested patient secondary to lipophilic cardiotoxin overdose is increasingly reported, with numerous documented cases of successful resuscitation outcome [1,2]
The role of ILE in hemodynamic instability secondary to tricyclic antidepressant (TCA) overdose has been the subject of few pre-clinical studies [3,4]
We report a case of multi-drug overdose with predominant TCA toxicity that exhibited ongoing hypotension after systemic alkalinisation, yet before infusion of vasopressor medications, which responded to ILE loading
Summary
Therapeutic use of intravenous lipid emulsion (ILE) in the arrested patient secondary to lipophilic cardiotoxin overdose is increasingly reported, with numerous documented cases of successful resuscitation outcome [1,2]. Background Therapeutic use of intravenous lipid emulsion (ILE) in the arrested patient secondary to lipophilic cardiotoxin overdose is increasingly reported, with numerous documented cases of successful resuscitation outcome [1,2]. We report a case of multi-drug overdose with predominant TCA toxicity that exhibited ongoing hypotension after systemic alkalinisation, yet before infusion of vasopressor medications, which responded to ILE loading.
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