title: "Lipid rescue" for tricyclic antidepressant cardiotoxicity.
abstract: BACKGROUND
  Tricyclic antidepressant (TCA) toxicity results predominantly from myocardial sodium-channel blockade. Subsequent ventricular dysrhythmias, myocardial depression, and hypotension cause cardiovascular collapse. Animal studies have demonstrated the effectiveness of intravenous lipid-emulsion in treating TCA cardiotoxicity.
  
  
  METHODS
  We report a case of dothiepin (tricyclic antidepressant) overdose causing refractory cardiovascular collapse, which seemed to be successfully reversed with lipid-emulsion therapy (Intralipid(®); Fresenius, Cheshire, UK).
  
  
  CONCLUSIONS
  Lipid emulsions are a potentially novel therapy for reversing cardiotoxicity seen in TCA overdose. Research is required into the role of lipid emulsion in the management of poisoning by oral lipophilic agents.
authors.affiliation: Department of Cardiology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Michael Stephen
authors.initials: MS
authors.lastname: Blaber
authors.forename: Jamal Nasir
authors.initials: JN
authors.lastname: Khan
authors.forename: Judith Anne
authors.initials: JA
authors.lastname: Brebner
authors.forename: Rachel
authors.initials: R
authors.lastname: McColm
mesh_terms: D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D004308:Dothiepin / Q000009:adverse effects*; D062787:Drug Overdose / Q000150:complications / Q000188:drug therapy*; D004562:Electrocardiography; D004655:Emulsions / Q000627:therapeutic use; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D010743:Phospholipids / Q000627:therapeutic use*; D013024:Soybean Oil / Q000627:therapeutic use*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D010743:Phospholipids; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil; D004308:Dothiepin