Cardiovascular Repercussions of Seizures During Cyclic Antidepressant Poisoning

Taboulet, P.; Michard, Frédèric; Muszynski, J; Galliot-Guilley, M.; Bismuth, C

doi:10.3109/15563659509017985

Cited by 38 publications

(16 citation statements)

References 28 publications

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“…One poison center-based study reported in 1993 that, over a 2-year period, TCAs alone accounted for 25% of all overdoseinduced convulsions (5). In a 1995 retrospective study of 388 consecutive patients with TCA poisoning admitted to the Fernand Widal Hospital in Paris over a 4-year period, 6.2% developed grand mal seizures, although this figure could underestimate the risk since some patients had also ingested benzodiazepines, which have anticonvulsant properties (6).…”

Section: Statement Of the Scope Of The Problem And Importance Of The mentioning

confidence: 99%

“…There were a number of articles in which the recognition of the amitriptyline ingestion was retrospective, so there was uncertainty about the actual amount ingested. Among these were five level 2b articles (16,53,(59)(60)(61), a single level 3b article (62), and five level 4 articles (6,48,(63)(64)(65). Also, there were over 50 level 4 or 6 articles in which detailed information was presented concerning 65 cases (see Table 5).…”

Section: Amitriptylinementioning

confidence: 99%

“…There was a single level 2b study (53) and four level 4 case series or case reports (6,22,48,66) that provided information on dose-effect relationships for clomipramine. The lowest dose associated with mild toxicity was 600 mg (53), and the lowest associated with severe toxicity was 750-1500 mg (22).…”

Section: Clomipraminementioning

confidence: 99%

“…There was a single level 2b study (53), a single level 4 case series (6), and a single case report (93) of trimipramine ingestion. Among these, the lowest dose of trimipramine associated with moderate toxicity was 1000 mg (53) and the lowest dose resulting in severe toxicity was 1200 mg (6).…”

Section: Trimipraminementioning

confidence: 99%

“…A report (level 4) of 24 adults with convulsions after TCA overdose found that the onset of convulsions occurred within 18 hours in all patients (6). In a level 4 retrospective review of 30 patients admitted with convulsions after TCA overdose, the onset of convulsions ranged from 0.5 to 9.3 hours.…”

Section: Duration Of Symptomsmentioning

confidence: 99%

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Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management

Woolf

Erdman

Nelson

et al. 2007

Clinical Toxicology

130

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of U.S. poison center data for 2004 showed over 12,000 exposures to tricyclic antidepressants (TCAs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce healthcare costs, and reduce life disruption for patients and caregivers. An evidencebased expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate prehospital triage and management of patients with suspected ingestions of TCAs by 1) describing the manner in which an ingestion of a TCA might be managed, 2) identifying the key decision elements in managing cases of TCA ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of TCAs alone. Co-ingestion of additional substances could require different referral and management recommendations depending on their combined toxicities. This guideline is based on the assessment of current scientific and clinical information. The panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) Patients with suspected self-harm or who are the victims of malicious administration of a TCA should be referred to an emergency department immediately (Grade D). 2) Patients with acute TCA ingestions who are less than 6 years of age and other patients without evidence of self-harm should have further evaluation including standard history taking and determination of the presence of co-ingestants (especially other psychopharmaceutical agents) and underlying exacerbating conditions, such as convulsions or cardiac arrhythmias. Ingestion of a TCA in combination with other drugs might warrant referral to an emergency department. The ingestion of a TCA by a patient with significant underlying cardiovascular or neurological disease should cause referral to an emergency department at a lower dose than for other individuals. Because of the potential severity of TCA poisoning, transportation by EMS, with close monitoring of clinical status and vital signs en route, should be considered (Grade D). 3) Patients who are symptomatic (e.g., weak, drowsy, dizzy, tremulous, pal...

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Section: Statement Of the Scope Of The Problem And Importance Of The mentioning

confidence: 99%