High-dose intravenous glucagon in severe tricyclic poisoning

Sensky, Penelope R.; Olczak, Stephen

doi:10.1136/pgmj.75.888.611

Cited by 25 publications

(13 citation statements)

References 4 publications

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“…Recent experimental studies have shown that many agents, such as L-NAME, a nitric-oxide synthase inhibitor, selective adenosine A 1 and A 2a receptor antagonists, and glucagon, are effective in reversing TCA-induced hypotension (Kalkan et al, 2004;Pentel et al, 1996;Tuncok et al, 2002;Kaplan et al, 2008). There are case reports suggesting the beneficial effects of vasopressin and glucagon in TCA overdose (Sensky and Olczak, 1999;Downes, 2003;Barry et al, 2006). Heard et al showed that TCA antibody fragments (TCA Fab) raise total serum TCA levels while lowering free levels in TCA-poisoned patients and no toxic effects were associated with the increase in TCA levels, but in this study, there were no significant changes in QRS duration, HR, or MAP associated with the Fab infusion (Heard et al, 2006).…”

Section: Discussionmentioning

confidence: 96%

An alternative antidote therapy in amitriptyline-induced rat toxicity model: theophylline

Oransay

Kalkan

Hocaoğlu

et al. 2010

Drug and Chemical Toxicology

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We planned this study in order to investigate the effects of theophylline on cardiovascular parameters in an anaesthetized rat model of amitriptyline toxicity. In the preliminary study, we tested theophylline as 1 mg/kg of bolus, followed by a 0.5-mg/kg infusion. Toxicity was induced by the infusion of 0.94 mg/kg/min of amitriptyline up to the point of a 40-45% inhibition of mean arterial pressure (MAP). The rats were randomized to two groups: a group of 5% dextrose bolus followed by 5% dextrose infusion, and another group with theophylline bolus followed by infusion. Amitriptyline caused a significant decrease in MAP and prolongation in QRS; however, it did not alter heart rate (HR). When compared to the dextrose group, theophylline administration increased MAP, shortened prolonged QRS duration, and increased HR (P < 0.05, respectively). There was no statistically significant difference in the results of arterial blood-gas analyses among the groups (P > 0.05). Bolus doses followed by a continuous infusion of theophylline were found to be effective in reversing the hypotension and QRS prolongation seen in amitriptyline toxicity. One of the possible explanations of this beneficial effect is nonselective adenosine antagonism of theophylline. Further studies are needed to reveal the exact mechanism of the observed effect.

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Section: Discussionmentioning

confidence: 96%

An alternative antidote therapy in amitriptyline-induced rat toxicity model: theophylline

Oransay

Kalkan

Hocaoğlu

et al. 2010

Drug and Chemical Toxicology

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“…Numerous case reports and laboratory investigations describe glucagon's effectiveness in reversing hypotension caused by overdoses of β-adrenergic blocking agents and calcium channel antagonists, although its mechanism of action would seem to make its effectiveness in calcium channel antagonists less likely than in overdoses from β-adrenergic blocking agents [101][102][103][104]. There are also reports of glucagon reversing TCA-induced hypotension [105,106]. In overdose patients, glucagon can be considered in hypotension unresponsive to the usual pressors (Level III recommendation).…”

Section: Vasoactive Agentsmentioning

confidence: 91%

Therapeutic Approach to the Critically Poisoned Patient

Schwarz¹

2016

Critical Care Toxicology

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“…40 mm Hg systolic rise after glucagon

Multiple drugs ingested in overdose.

Patient also received sodium bicarbonate, phenytoin and isoprenaline and fluid resuscitation

Cardiac rhythmNo response to 1 mg bolus glucagon. Broad complex reverted to sinus after 10 mg bolusSensky et al , 1999, UK9336-year-old OD admission. Toxicology dothiepin 2.58 mg/l, desmethyldothiepin 0.51 mg/l, paracetamol 135 mg/l, diazepam 0.33 mg/l, nordiazepam 0.12 mg/lCase reportBlood pressureNo response to 1 mg bolus glucagon.…”

Section: Relevant Papersmentioning

confidence: 99%

Guidelines in Emergency Medicine Network (GEMNet): guideline for the management of tricyclic antidepressant overdose

Body

Bartram

Azam

et al. 2011

Emergency Medicine Journal

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The Guidelines in Emergency Medicine Network (GEMNet) has been created to promote best medical practice in a range of conditions presenting to emergency departments (EDs) in the UK. This guideline presents a summary of the best available evidence to guide the management of adult patients who present to the ED following an overdose of tricyclic antidepressant agents (TCA). The document has been developed following discussion among emergency physicians to decide which topics would benefit from the development of clinical guidelines. The document is intended as a guideline for use in the ED by emergency physicians and is based on the review of the best existing evidence for the diagnostic tools and treatments used in this setting. The document is summarised as a clinical decision support guideline that has been presented as an easy to follow algorithm. The intention is for each guideline to be updated and reviewed as further evidence becomes available. The formal revision date has been set at 5 years from publication, although the guideline is subject to continuous informal review.

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High-dose intravenous glucagon in severe tricyclic poisoning

Cited by 25 publications

References 4 publications

An alternative antidote therapy in amitriptyline-induced rat toxicity model: theophylline

An alternative antidote therapy in amitriptyline-induced rat toxicity model: theophylline

Therapeutic Approach to the Critically Poisoned Patient

Guidelines in Emergency Medicine Network (GEMNet): guideline for the management of tricyclic antidepressant overdose

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