Arterial Blood Gas Analysis and the Outcome of Treatment in Tricyclic Antidepressants Poisoned Patients with Benzodiazepine Coingestion

Abstract

Background. Poisoning with tricyclic antidepressants (TCAs) is still a major concern for emergency physicians and intensivists. Concomitant ingestion of other psychoactive drugs especially benzodiazepines with TCAs may make this clinical situation more complex. This study aimed to compare the arterial blood gas (ABG) values and the outcome of treatment in patients with coingestion of TCA and benzodiazepine (TCA + BZD) poisoning and TCA poisoning alone. Methods. In this cross-sectional study which was carried out in a tertiary care university hospital in Iran, clinical and paraclinical characteristics of one hundred forty TCA only or TCA + BZD poisoned patients (aged 18–40 years) were evaluated. ABG analysis was done on admission in both groups. Outcomes were considered as survival with or without complication (e.g., intubation) and the frequency of TCA poisoning complications. Results. Arterial pH was significantly lower in TCA + BZD poisoning group compared with TCA only poisoning group (7.34 ± 0.08 and 7.38 ± 0.08, resp.; P = 0.02). However, other complications such as seizure, and the need for the endotracheal intubation were not significantly different. All patients in both groups survived. Conclusions. Concomitant TCA plus BZD poisoning may make the poisoned patients prone to a lower arterial pH level on hospital admission which may potentially increases the risk of cardiovascular complications in TCA poisoning.

Comparing the Effectiveness of Three Scoring Systems in Outcome Prediction of Acute Tricyclic Antidepressants Poisoning Cases

“…In the current study, the age of the studied cases ranged from 16 to 70 years with a mean of 25.4 ± 9.8.0. This was nearly similar to the mean age reported by Yaraghi et al (2015) and Eizadi-Mood et al (2016). The majority of cases were females (89%), from urban areas (72.5%) and were unemployed (49.5%).…”

“…The mean systolic and diastolic blood pressure were 117.5± 17.8 and 74.4± 12.8 respectively. This was nearly similar to mean systolic and diastolic blood pressure of Yaraghi et al (2015) study (107.8± 17.4 and 71.4± 12.5 respectively) and of Avci et al (2020) study (116.4± 12.4 and 71.8± 8.5 respectively). Hypotension was recorded in only 4.6% of cases of the present study while it was reported in 15% of cases of Saleh et al (2013) study.…”

“…The mean GCS was 12.4 ± 3.0. Level of consciousness was altered in 71% of the cases of Saleh et al (2013) study, while it was altered in 84.2% in Yaraghi et al (2015) study. The median GCS was 14 and 15 respectively in Graudins et al (2002) and Yildiz et al (2020) studies.…”

The Effect of Methylphenidate on Reed Scaling in Benzodiazepine Poisoning: A Prospective Trial

“…Therefore, our subjects who were younger than 20 years of age demonstrated a respiratory acidosis condition on admission. In one study, Arterial Blood Gas (ABG) parameters in patients with Benzodiazepine (BZD) poisoning were measured and the mean pH level was significantly lower than that in patients with TCA poisoning [ 27 ]. It is known that rapid Na+ channel blockade in the heart is sensitive to arterial blood pH, thus acidosis can aggravate cardiovascular toxicity [ 28 ].…”

What are the Predictive Factors for the Treatment Outcomes in Multi Drug Poisoning Including Antidepressants/Antipsychotic Drugs?

“…There have been studies on the effects of intoxication with antidepressants or antipsychotics alone in the outcome of the patients. [ 4 5 6 7 8 9 10 ] In this study, we evaluated the predicting factors for the outcome of the patients intoxicated with antidepressants, antipsychotics, and their combination with and without other drugs as no study reported yet.…”