title: Tricyclic poisoning--successful management of ventricular fibrillation following massive overdose of imipramine.
abstract: Serious complications from tricyclic antidepressant (TCA) overdose are uncommon. We present a case of massive imipramine overdose complicated by ventricular fibrillation and a prolonged period of cardiovascular collapse. A total of 400 mmol of sodium bicarbonate, 5 mg of adrenaline and 80 mg of sotalol were given during 50 minutes of cardiac arrest. The patient made a full recovery with no apparent neurological sequelae. The highest TCA plasma level we could find in the published literature was 4873 ng/ml4; our patient's peak TCA level was 6000 ng/ml. Tricyclic antidepressant overdose is a common cause of intensive care unit admission. It has a low mortality rate.
authors.affiliation: Department of Anaesthesia, Wollongong Hospital, N.S.W.
authors.forename: D J
authors.initials: DJ
authors.lastname: Sandeman
authors.forename: T I
authors.initials: TI
authors.lastname: Alahakoon
authors.forename: S C
authors.initials: SC
authors.lastname: Bentley
mesh_terms: D000322:Adrenergic Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000097:blood / Q000506:poisoning*; D003422:Critical Care; D003863:Depression / Q000188:drug therapy; D062787:Drug Overdose; D004554:Electric Countershock; D004830:Epilepsy, Tonic-Clonic / Q000139:chemically induced / Q000188:drug therapy; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D007099:Imipramine / Q000097:blood / Q000506:poisoning*; D011644:Puerperal Disorders / Q000188:drug therapy; D012769:Shock / Q000139:chemically induced / Q000188:drug therapy; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use; D013015:Sotalol / Q000008:administration & dosage / Q000627:therapeutic use; D014693:Ventricular Fibrillation / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy
chemical_list: D000322:Adrenergic Agonists; D000889:Anti-Arrhythmia Agents; D000929:Antidepressive Agents, Tricyclic; D017693:Sodium Bicarbonate; D013015:Sotalol; D007099:Imipramine; D004837:Epinephrine