Hızır AKDEMİR, Yavuz CENİK, Mustafa URAS, Neslihan ÜNAL

Successful treatment with intravenous lipid emulsion of severe tricyclic antidepressant intoxication

An overdose of amitriptyline has neurological and cardiovascular side effects (psychosis, lethargy, coma, hypotension, and dysrhythmia). A 19-year-old female patient was admitted to our emergency service after a suicide attempt by amitriptyline ingestion of unknown amount. Her follow-up demonstrated deteriorating consciousness and vital signs, she had a generalized tonic-clonic seizure, and her electrocardiogram (ECG) revealed QRS interval widening followed by a ventricular tachycardia (VT) attack. The patient was treated with intravenous (IV) diazepam (Diazem®) to control the epileptic seizure, IV lidocaine (Aritmal®) to stop the VT attack, and IV sodium bicarbonate due to QRS interval widening. The patient was given norepinephrine bitartrate (Steradine®) and dopamine hydrochloride (Dopamine®) due to low blood pressure. Intravenous lipid emulsion (ILE) therapy was started due to the uncontrolled rhythm and hypotension. Here, we present a case report of a comatose patient with dysrhythmia due to amitriptyline overdose who responds to ILE therapy.

Keywords:

Tricyclic antidepressant, Intoxication Dysrhythmia, Coma, Lipid emulsion, Treatment,

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