Tricyclic antidepressant poisoning on emergency department: critical patients

Abstract

Tricyclic antidepressant’s (TCA) are used primarily for the treatment of major depression. TCA overdose is a life threatening situation which is commonly seen in the emergency department. The clinical presentation of TCA toxicity varies tremendously from mild antimuscarinic symptoms to severe cardiotoxicity. The most common toxicity occurs in cardiovascular, the peripheral nervous system and the central nervous system. Indications for sodium bicarbonate therapy include QRS complex widening greater than 100 ms, hypotension refractory to şuid hydration, terminal right axis deviation aVr of greater than 3 mm, ventricular dysrhythmias, cardiac arrest, acidosis and seizure. Administration of hypertonic saline, glucagone, adenosine antagonists and TCA-antibodies has also been of benefit in this patient’s treatment.