Adult respiratory distress syndrome and late death following imipramine overdose: a case report.
Adult respiratory distress syndrome (ARDS) after tricyclic antidepressant (TCA) overdose has been reported, but has not received as much attention in the literature as hemodynamic instability, cardiac arrhythmias or seizures. This report concerns a 33-year-old female who ingested a large amount of imipramine in an attempted suicide. She developed deep coma, hypotension, cardiac dysrhythmias and seizures. Although she survived initially, ARDS developed and she died of severe hypoxia nine days later. Her lung injury may have been the result of a variety of factors including prolonged hypotension, aspiration pneumonia, sepsis or a direct action on the lung parenchyma by imipramine. The literature pertaining to etiology, epidemiology, pathophysiology and management of TCA-induced lung injury has been reviewed. In one series of severe TCA overdose, an ARDS rate of 9% was reported. The risk of developing pulmonary edema and ARDS should be considered in severe TCA-poisoned patients. To try to prevent this complication, early intubation should be considered to avoid aspiration, and cautious volume loading, plus judicious use of alpha-adrenergic agonists, is indicated to prevent protracted hypotension.
Department of Emergency Medicine, Chang-Gung Memorial Hospital-Linkou, Taipei, Taiwan, R.O.C.
T F
TF
Chiu
C C
CC
Yang
J
J
Ger
J F
JF
Deng
M J
MJ
Bullard
D000328:Adult; D062787:Drug Overdose; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007099:Imipramine / Q000008:administration & dosage / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000139:chemically induced*
D007099:Imipramine