Amitriptyline-induced Brugada pattern fails to respond to sodium bicarbonate.
This report describes a Brugada electrocardiographic pattern after tricyclic antidepressant intoxication that fails to resolve following sodium bicarbonate treatment. A 50-year-old male ingested 13.6 grams of amitriptyline and presented in cardiopulmonary arrest. After initial resuscitation, the patient developed a Brugada electrocardiographic pattern. The pattern persisted despite intravenous administration of 700 mEq of sodium bicarbonate. Five hours after the last dose of sodium bicarbonate and 18 hours after initial presentation, the Brugada pattern resolved. No co-ingestants were ingested and an ischemic pattern was not seen on electrocardiogram. The serum amitriptyline level was >1000 ng/ml. Response of the tricyclic-induced Brugada pattern to sodium bicarbonate has not been previously reported.
Bebarta
Vikhyat S
VS
Director of Medical Toxicology, Department of Emergency Medicine, Wilford Hall Medical Center, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA. vikbebarta@yahoo.com
Waksman
Javier C
JC
D000639:Amitriptyline / Q000097:blood / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000097:blood / Q000506:poisoning*; D053840:Brugada Syndrome / Q000139:chemically induced / Q000188:drug therapy* / Q000378:metabolism; D062787:Drug Overdose; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D015222:Sodium Channels / Q000378:metabolism; D017211:Treatment Failure
D000929:Antidepressive Agents, Tricyclic; D015222:Sodium Channels; D000639:Amitriptyline; D017693:Sodium Bicarbonate