Tricyclic antidepressant poisoning

Glauser, Jonathan

doi:10.3949/ccjm.67.10.704

Cited by 53 publications

(23 citation statements)

References 9 publications

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“…There are numerous cases or case series (level 4) in which patients with TCA overdoses apparently responded favorably to sodium bicarbonate (improved vital signs, cessation of dysrhythmias or convulsions, reduction in acidosis, and/or improved cardiac conduction) in a temporally consistent manner (22,23,54,89,90,96,149,152,154,158,171,(196)(197)(198)(199)(200)(201)(202)(203)(204)(205)(206)(207)(208)(209)(210)(211)(212)(213)(214). In other cases, bicarbonate was given either without improvement or with an unreported response (3,43,82,92,154,173,174,197,209,212,213,(215)(216)(217)(218)(219)(220)…”

Section: Sodium Bicarbonatementioning

confidence: 99%

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Woolf

Erdman

Nelson

et al. 2007

Clinical Toxicology

130

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of U.S. poison center data for 2004 showed over 12,000 exposures to tricyclic antidepressants (TCAs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce healthcare costs, and reduce life disruption for patients and caregivers. An evidencebased expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate prehospital triage and management of patients with suspected ingestions of TCAs by 1) describing the manner in which an ingestion of a TCA might be managed, 2) identifying the key decision elements in managing cases of TCA ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of TCAs alone. Co-ingestion of additional substances could require different referral and management recommendations depending on their combined toxicities. This guideline is based on the assessment of current scientific and clinical information. The panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) Patients with suspected self-harm or who are the victims of malicious administration of a TCA should be referred to an emergency department immediately (Grade D). 2) Patients with acute TCA ingestions who are less than 6 years of age and other patients without evidence of self-harm should have further evaluation including standard history taking and determination of the presence of co-ingestants (especially other psychopharmaceutical agents) and underlying exacerbating conditions, such as convulsions or cardiac arrhythmias. Ingestion of a TCA in combination with other drugs might warrant referral to an emergency department. The ingestion of a TCA by a patient with significant underlying cardiovascular or neurological disease should cause referral to an emergency department at a lower dose than for other individuals. Because of the potential severity of TCA poisoning, transportation by EMS, with close monitoring of clinical status and vital signs en route, should be considered (Grade D). 3) Patients who are symptomatic (e.g., weak, drowsy, dizzy, tremulous, pal...

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Section: Sodium Bicarbonatementioning

confidence: 99%

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Woolf

Erdman

Nelson

et al. 2007

Clinical Toxicology

130

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“…Klinisches Einsatzgebiet von TCA sind seit dem Ende der 50er-Jahre nicht nur Depressionen, sondern auch chronische Schmerzsyndrome, Panikstörungen, Migräneprophylaxe und periphere Neuropathien [6].…”

Section: Hintergrundunclassified

“…Schwere Vergiftungen sind gekennzeichnet durch Krampfanfälle, Bewusstseinsstörungen bis hin zu Koma, Hypoventilation oder Azidose [6,7,18].…”

Section: Pathophysiologieunclassified

“…Magenspülung und/oder Aktivkohletherapie (30-50 g Aktivkohle oral) [6,7]. Großzügige Indikationsstellung zu Intubation und Beatmung bei respiratorischer Insuffizienz und Bewusstseinstrübung werden empfohlen [15].…”

Section: Behandlung Der Akuten Intoxikationunclassified

“…Hypotensive Blutdruckwerte sollten vornehmlich durch Volumengabe angehoben werden; bei persistierender Hypotension (Schock) ist eine Katecholamingabe oder die einmalige Bolusapplikation hypertoner Infusionslösun-gen in Erwägung zu ziehen [6,9,10,15]. Dabei können Dopamin oder Dobutamin sowie Norepinephrin oder Epinephrin genutzt werden.…”

Section: Behandlung Der Akuten Intoxikationunclassified

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Hypotones Kreislaufversagen und metabolische Azidose nach suizidaler Mischintoxikation mit Trimipramin und Quetiapin

Gabel

Hinkelbein

2004

Der Anaesthesist

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The case of a 44-year-old female patient is reported, who ingested trimipramine and quetiapine in a suicide attempt. Initially sinus tachycardia and hypotension were seen, which resulted in a hypotensive cardio-circulatory failure despite fluid therapy and administration of catecholamines. Because of the life-threatening situation and the fact that the ingestion was 2 h prior to admission, a rapid transport to the next hospital was preferred to treatment with active charcoal. Intoxication with tricyclic antidepressants are very common in Europe and have a mortality of up to 15% in severe cases. The specific therapy consists of airway management, hemodynamic stabilization and primary elimination of the poison. Secondary detoxication is less important. The administration of the antidote physostigmine is controversial but carbo medicinalis should be given orally or via a gastric tube.

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Pharmaceuticals

Jiang

Acosta

2004

Patty's Toxicology

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This article provides a comprehensive summary of common adverse side effects associated with key pharmaceutical drugs used in the treatment of selected diseases and disorders. The focus of this chapter is on the use of drugs associated with key organs and physiological functions of the body. The main topics covered are Anesthetics, Analgesics, Sedative Hypnotics, Anti‐physchotic, Antiepileptics, Neurodegenerative Disorders, Adrenergic and Cholinergic Agents, Cardiovascular Drugs, and Hormone Antagonists.

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Tricyclic antidepressant poisoning

Cited by 53 publications

References 9 publications

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Hypotones Kreislaufversagen und metabolische Azidose nach suizidaler Mischintoxikation mit Trimipramin und Quetiapin

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