Prolonged use of intravenous lipid emulsion in a severe tricyclic antidepressant overdose.

Abstract

INTRODUCTION:

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.

CASE REPORT:

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.

DISCUSSION:

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: Ravi Agarwala, Syed Zaki Ahmed, Timothy J Wiegand
• Journal: Journal of medical toxicology : official journal of the American College of Medical Toxicology (J Med Toxicol) Vol. 10 Issue 2 Pg. 210-4 (Jun 2014) ISSN: 1937-6995 [Electronic] United States
• PMID: 24173885 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antidepressive Agents, Tricyclic
• Fat Emulsions, Intravenous
• Amitriptyline

Topics

• Adult
• Amitriptyline (chemistry, poisoning)
• Antidepressive Agents, Tricyclic (chemistry, poisoning)
• Combined Modality Therapy (adverse effects)
• Drug Overdose (physiopathology, therapy)
• Fat Emulsions, Intravenous (adverse effects, therapeutic use)
• Humans
• Hydrophobic and Hydrophilic Interactions
• Hyperlipidemias (etiology, prevention & control)
• Male
• Recurrence
• Severity of Illness Index
• Shock (etiology, prevention & control)
• Suicide, Attempted
• Time Factors
• Treatment Outcome