PMID- 29854605
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2214-7500 (Electronic)
IS  - 2214-7500 (Linking)
VI  - 5
DP  - 2018
TI  - The return of an old nemesis: Survival after severe tricyclic antidepressant 
      toxicity, a case report.
PG  - 357-362
LID - 10.1016/j.toxrep.2018.03.009 [doi]
AB  - Tricyclic antidepressants (TCAs) were first approved by the Food and Drug 
      Administration (FDA) for use as antidepressants in the 1950s. Although their 
      function as an antidepressant in the U.S. has largely been replaced by newer and 
      safer alternatives, they are still prescribed for various conditions, including 
      chronic pain and intractable depression. We will discuss a case of a TCA overdose 
      presenting with generalized tonic-clonic seizures and multiple recurrent cardiac 
      arrests. This is a case of a 34 year-old female who was brought in by Emergency 
      Medical Services (EMS) with generalized tonic clonic seizure, status post 
      intentional ingestion of multiple drugs. Her vital signs were: 
      Temperature-38.8  degrees C, Heart Rate-140 beats per minute, Respiratory Rate (RR)-25 
      breaths per minute, Blood Pressure (BP)-139/77 mmHg, Oxygen Saturation (SaO2)-99% 
      on 100% nonrebreather facemask (NRB). Her electrocardiogram (EKG) showed a 
      widened ventricular tachyarrhythmia and she was immediately given an ampule of 
      sodium bicarbonate. Over the span of the subsequent 2 h, she had recurrent 
      pulseless ventricular tachycardic arrest 5 times in the emergency department 
      (ED). After 5 days of further stabilization, the patient had a subsequent 
      complete recovery with normal neurological function at discharge from the medical 
      unit. In the ED it is imperative that we understand the now uncommon presentation 
      of a TCA overdose in order to initiate immediate treatment. It is also important 
      to understand the optimal treatment choices in patients that presents with TCA 
      toxicity, especially arrhythmias that are refractory to initial treatment 
      choices. Overall, severe TCA poisoning is often fatal; however, we demonstrated 
      that with high quality resuscitative efforts, despite multiple arrests, survival 
      to discharge with normal neurological outcome is possible.
FAU - Giwa, Al
AU  - Giwa A
AD  - Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, One 
      Gustave L. Levy Place, New York, NY, 10029-6574, United States.
FAU - Oey, Edwin
AU  - Oey E
AD  - Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, One 
      Gustave L. Levy Place, New York, NY, 10029-6574, United States.
LA  - eng
PT  - Case Reports
DEP - 20180310
PL  - Ireland
TA  - Toxicol Rep
JT  - Toxicology reports
JID - 101630272
PMC - PMC5977411
OTO - NOTNLM
OT  - Acidosis
OT  - Cardiac arrythmia
OT  - Lidocaine
OT  - Overdose
OT  - Pulseless ventricular tachycardia
OT  - Recurrent cardiac arrest
OT  - Sodium bicarbonate
OT  - Torsades
OT  - Toxicity
OT  - Toxicology
OT  - Tricyclic antidepressant
OT  - VTach
OT  - Ventricular tachycardia
OT  - Wide complex tachycardia
EDAT- 2018/06/02 06:00
MHDA- 2018/06/02 06:01
PMCR- 2018/03/10
CRDT- 2018/06/02 06:00
PHST- 2018/01/06 00:00 [received]
PHST- 2018/02/28 00:00 [revised]
PHST- 2018/03/05 00:00 [accepted]
PHST- 2018/06/02 06:00 [entrez]
PHST- 2018/06/02 06:00 [pubmed]
PHST- 2018/06/02 06:01 [medline]
PHST- 2018/03/10 00:00 [pmc-release]
AID - S2214-7500(18)30011-8 [pii]
AID - 10.1016/j.toxrep.2018.03.009 [doi]
PST - epublish
SO  - Toxicol Rep. 2018 Mar 10;5:357-362. doi: 10.1016/j.toxrep.2018.03.009. 
      eCollection 2018.