Survival after severe amitriptyline poisoning with prolonged ventricular tachycardia and cardiac arrest

Abstract

BackgroundTricyclic antidepressants (TCA) are becoming one of the most frequently used substances in self poisoning. Significant morbidity and mortality associated with TCA overdose are often related to and refractory hypotension. We report the first case of survival after severe amitriptyline poisoning, leading to prolonged cardiac arrest and ventricular tachycardia (VT), resuscitated with 3 h of uninterrupted cardiac massage and Direct current (DC) shocks.Case presentationA 25 year old girl presented with severe amitriptyline poisoning causing pulseless VT and prolonged cardiac arrest. After 3 h of uninterrupted external cardiac massage, together with nine DC shocks and intra venous bicarbonate injections the rhythm reverted to a nodal tachycardia, initial 2D echocardiogram showed left ventricular dysfunction, which recovered to normal after 2 weeks and the patient had a complete recovery subsequently.ConclusionOur case highlights the importance of continued resuscitation in patients presenting with TCA poisoning and resistant arrhythmia, especially in young and otherwise healthy patients.

Physiologically based pharmacokinetic-quantitative systems toxicology and safety (PBPK-QSTS) modeling approach applied to predict the variability of amitriptyline pharmacokinetics and cardiac safety in populations and in individuals

“…The predicted mean QTcB in the study mimicking that described by Paksu et al [ 12 ] was 512 ms (488 ms observed in the clinic). In case of a virtual 25-year-old female with TdP described by Abeyaratne et al [ 52 ], the arrhythmia was simulated in two out of ten virtual patients.…”

“…Indeed, the severity of clinical findings of AT intoxication is weakly correlated with AT serum levels [ 12 ]. Abeyaratne et al [ 52 ] described the case of 25-year old female intoxicated with ca. 500 mg of AT who developed TdP arrhythmia 2 h after poisoning.…”

“…Since only the postdose time interval of ECG measurement was available, the cardiac concentrations corresponding to the simulated maximal plasma concentration of AT in that time interval were used. Cases without drug plasma concentrations reported [ 12 , 50 – 52 ]: The free cardiac concentrations of AT and NT were predicted in PBPK model based on the estimated toxic dose, and used as input in CSS. …”

“…Cases without drug plasma concentrations reported [ 12 , 50 – 52 ]: The free cardiac concentrations of AT and NT were predicted in PBPK model based on the estimated toxic dose, and used as input in CSS.…”

Trisiklik Antidepresan Zehirlenmelerinde Adora Risk Skorlaması

“…Erken risk sınıflaması bu riski azaltabilir. TA zehirlenmelerinde, sebep çoğunlukla ventriküler aritmilerdir ve kardiopulmoner resüsitasyon süresini uzatmak mortalite oranını azaltabilmektedir (16).…”