Cardiac arrest and arrhythmias due to self‐poisoning with imipramine

Pearson, Jessica; Jones, E. Sherwood; Gabbe, D. M.

doi:10.1111/j.1365-2044.1969.tb02807.x

Cited by 5 publications

(2 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the role of treatment of hyperglycaemia with insulin and metformin has been evaluated in critically ill patients in the studies by Goldberg and Mojtahedzadeh, none of these modalities was performed in poisoning cases. [38] Acute poisoning-induced hyperglycaemia may be a good predictor of severity of poisoning and clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Acute Poisoning Cases Treated in Intensive Care Unit at Rural Tertiary Care centre

Dr. M.A. WAHAB ZUBAIR

2021

IARJMSR

View full text Add to dashboard Cite

Background: Acute poisoning with various substance is common everywhere. Earlier initial resuscitation, gastric decontamination and use of specific antidotes, better is the outcome. The aim of the study was to characterize the poisoning cases admitted to the tertiary care teaching Hospital. Material and Methods: This is Prospective, observational, descriptive study was conducted to investigate the clinical characteristics and epidemiological patterns of acute poisoning admission into ICU of 137 cases. The inclusion criteria were: Either gender with Age > 13 years and chief complaint of acute poisoning included those who had undergone exposure to poison either by household or agricultural pesticides, stings bite, snake bite, industrial toxins, toxic plants, drug or miscellaneous products. Results: 137 of poisoned cases were enrolled in this study, the majority of poison cases were between 21-30 years accountable 60.6 % were male and gender ratio of the patients’ male: female was 1.53:1. The majority of all cases (61.3%) were due to suicidal poisoning. The exposure substances identified as most commonly encountered in the ICU included OPP (37.2%), Food Poisoning 15.3%, Alcohol intoxication, followed by overdose of drugs, (16.7%, 10.9%, respectively). Specific antidote 66.4% were given and Ventilator not received by 68.6% patients. Conclusions: The tertiary care hospitals of the Moinabad region, indicate that significant opportunities for reducing mortality are achieved by better medical management.

show abstract

Section: Discussionmentioning

confidence: 99%

Acute Poisoning Cases Treated in Intensive Care Unit at Rural Tertiary Care centre

Dr. M.A. WAHAB ZUBAIR

2021

IARJMSR

View full text Add to dashboard Cite

show abstract

“…Gastric lavage is the only method of removing the drug. This must be performed with the usual precautions, but in view of the bursts of ventricular tachycardia associated with endotracheal intubation in both cases and the cardiac arrest during endotracheal intubation in the case described by Pearson, Jones, and Gabbe (1969), it may be wise to postpone intubation and gastric lavage until any severe ventricular arrhythmia has been controlled (Sunshine and Yaffe, 1963;Steel et al, 1967).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Severe Imipramine Poisoning

Young¹,

Galloway²

1971

Archives of Disease in Childhood

View full text Add to dashboard Cite

The clinical effects and treatment of imipramine and amitriptyline poisoning have been reviewed by Giles (1963) and Steel, O'Duffy, and Brown (1967). The majority of cases are mild and recover spontaneously. The severe case is characterized by coma, convulsions, and cardiac arrhythmias. There is the added risk of respiratory depression and hypotension. Poisoning is severe if the dose of the drug ingested exceeds 20 mg/kg (Steel et al., 1967). Cairncross and Gershon (1962) have shown that the tachycardia that follows administration of these drugs in low dosage is due to vagal block. Larger doses have a direct action on the myocardium to cause AV block, extrasystoles, ventricular tachycardia, widening of the QRS complex, ST depression, and abnormal T waves. They also noted that an increase in the load on the heart potentiated this toxic effect. ECG changes have been described by Barnes, Kong, and Wu (1968) Two hours after admission tracheal intubation was carried out and the child was placed in an oxygenenriched atmosphere. Gastric lavage and bladder catheterization were done. Further episodes of convulsions and ventricular tachycardia occurred and were controlled by lignocaine (70 mg over 5 hours) and by paraldehyde.Fourteen hours after admission he became limp and comatose. Cardiac impulse was not recordable. Defibrillation after failure of external massage restored the heart action. Tracheal suction caused further ventricular tachycardia when cardiac impulse again failed and he became apnoeic. External massage restarted the heart. He was reintubated and connected to a ventilator. 19 hours after admission he tended to 'fight' the ventilator and was making spontaneous movements. Repeated electrolyte and blood gas estimations were normal. 22 hours after admission he was taken off the ventilator and intravenous drip was discontinued 7 hours later. Convulsions were controlled by promazine and diazepam.On the second day he became more conscious and could swallow. Heart action remained normal. On the third day he was able to hold a cup and drinkthere were occasional jerky movements when disturbed but no true convulsions. No further sedation was needed. ECG showed 1st degree AV block, but was otherwise normal.The following day he was irritable but conscious and alert. He continued to improve and when discharged 13 days after admission was normal. Phenobarbitone 60 mg and paraldehyde 2 ml were given intramuscularly, and as convulsions were not controlled, neostigmine was administered. Endotracheal intubation and gastric lavage were carried out.

show abstract

Poisoning Due to Tricyclic Antidepressant Overdosage

Crome

1986

Medical Toxicology

View full text Add to dashboard Cite

Tricyclic antidepressants are among the commonest causes of both non-fatal and fatal drug poisoning in the world. Their toxicity is due to effects on the brain, the heart, the respiratory system and the parasympathetic nervous system. Symptoms usually appear within 4 hours of an overdose and all but the most seriously poisoned patients recover within 24 hours. The most common clinical features are dry mouth, blurred vision, dilated pupils, sinus tachycardia, pyramidal neurological signs, and drowsiness. In severe poisoning, there may be coma, convulsions, respiratory depression, hypotension and a wide range of electrocardiographic (ECG) abnormalities. The most frequent findings on the ECG are prolongation of the PR and QT intervals; the tracing may resemble bundle branch block or supraventricular or ventricular tachycardias. Treatment of poisoning due to the tricyclic antidepressants is essentially supportive, there being insufficient evidence at present to recommend the use of methods to increase elimination of the drug from the body. Gastric aspiration and lavage should be performed if more than 750 mg of drug have been taken. There must be regular monitoring for hypoxia, acidosis and hypokalaemia and these complications should be corrected enthusiastically. Convulsions should be treated with diazepam or chlormethiazole. Muscular paralysis and artificial ventilation should be employed if anticonvulsants are ineffective. Hypotension should be treated firstly by fluid replacement and then with sympathomimetic agents (dopamine or dobutamine). Antiarrhythmic drugs should only be employed if there is evidence of circulatory failure which fails to respond to correction of hypotension. Sodium bicarbonate infusions should be given to cardiotoxic patients who are acidotic and are worth trying even if the patient is not acidotic. Although physostigmine salicylate will reverse most of the features of tricyclic antidepressant poisoning, its effects are short-lived in serious toxicity and it can produce dangerous side effects; physostigmine should therefore be reserved for those patients who have complications of coma or who have resistant cardiotoxicity or convulsions. Drug screening and quantitative determination of tricyclic antidepressant serum concentrations are useful in a minority of patients who have severe, unusual or prolonged symptoms.

show abstract

Cardiac arrest and arrhythmias due to self‐poisoning with imipramine

Cited by 5 publications

References 3 publications

Acute Poisoning Cases Treated in Intensive Care Unit at Rural Tertiary Care centre

Acute Poisoning Cases Treated in Intensive Care Unit at Rural Tertiary Care centre

Treatment of Severe Imipramine Poisoning

Poisoning Due to Tricyclic Antidepressant Overdosage

Contact Info

Product

Resources

About