Terlipressin as an adjunct vasopressor in refractory hypotension after tricyclic antidepressant intoxication.
OBJECTIVE
To report the management of cardiovascular failure refractory to standard catecholamine therapy with terlipressin in a patient with tricyclic antidepressant (TCA) intoxication.


METHODS
A 41-year-old woman, with suicidal ingestion of 11.25 g amitriptyline and 1500 mg diclofenac, was admitted to the emergency department. After 30 min in ventricular fibrillation, with ongoing CPR, she regained a potentially perfusing rhythm, but with hypotension refractory to standard catecholamine therapy with adrenaline, 2 microg/kg/min (norepinephrine); adrenaline, 1 microg/kg/min (epinephrine) until 55 min after admission. An injection of 1 mg terlipressin restored mean arterial blood pressure >65 mmHg within 10 min. Ten hours after admission to the intensive care unit, catecholamine support could be withdrawn because of a stable haemodynamic state. Within 7 days, all organ function recovered, and the patient regained full neurological function.


CONCLUSIONS
Successful management of cardiovascular failure with terlipressin after TCA intoxication refractory to catecholamines suggests a potential role for terlipressin as an adjunct vasopressor in severely hypotensive patients.
Zuidema
Xander
X
The Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
Dünser
Martin W
MW
Wenzel
Volker
V
Rozendaal
Frans W
FW
de Jager
Cornelis P C
CP
D000328:Adult; D000639:Amitriptyline / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D002395:Catecholamines / Q000627:therapeutic use; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000503:physiopathology*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077585:Terlipressin; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000929:Antidepressive Agents, Tricyclic; D000959:Antihypertensive Agents; D002395:Catecholamines; D014662:Vasoconstrictor Agents; D000639:Amitriptyline; D008236:Lypressin; D000077585:Terlipressin