title: Prolonged use of intravenous lipid emulsion in a severe tricyclic antidepressant overdose.
abstract: BACKGROUND
  Intravenous lipid emulsion (ILE) resuscitation is now frequently being used for severe overdoses due to lipophilic drugs. However, the optimal dose, duration, and safety are still unclear.
  
  
  METHODS
  A patient with refractory cardiovascular collapse following an amitriptyline overdose was treated with ILE with initial improvement. Instability recurred after ILE discontinuation and lipid therapy was restarted, but high-dose treatment was complicated by severe lipemia. A low-dose infusion was instead used, and the patient did not experience further toxicity despite amitriptyline levels in the toxic range for 21 days. He survived to discharge without long-term sequelae.
  
  
  CONCLUSIONS
  A low-dose infusion of ILE was well tolerated and may have successfully prevented recurrent toxicity in a case of severe tricyclic antidepressant overdose.
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA, ragarwal@wakehealth.edu.
authors.forename: Ravi
authors.initials: R
authors.lastname: Agarwala
authors.forename: Syed Zaki
authors.initials: SZ
authors.lastname: Ahmed
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wiegand
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000737:chemistry / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000737:chemistry / Q000506:poisoning*; D003131:Combined Modality Therapy / Q000009:adverse effects; D062787:Drug Overdose / Q000503:physiopathology / Q000628:therapy*; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D057927:Hydrophobic and Hydrophilic Interactions; D006949:Hyperlipidemias / Q000209:etiology / Q000517:prevention & control; D008297:Male; D012008:Recurrence; D012720:Severity of Illness Index; D012769:Shock / Q000209:etiology / Q000517:prevention & control; D013406:Suicide, Attempted; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D005217:Fat Emulsions, Intravenous; D000639:Amitriptyline