Successful Outcome Following Intravenous Lipid Emulsion Rescue Therapy in a Patient with Cardiac Arrest Due to Amitriptyline Overdose

Abstract

Management of emergency care Background:The management of patients with tricyclic antidepressant drug overdose can be a challenge for the emergency department physician. Tricyclic antidepressants block alpha-adrenergic receptors and the anticholinergic effects may lead to cardiotoxicity, resulting in arrhythmias and hypotension that can lead to patient mortality. This report is of a case of a 28-year-old woman who presented with cardiac arrest due to amitriptyline overdose and who responded to intravenous lipid emulsion (ILE) therapy. Case Report:A 28-year-old woman was admitted to the emergency department with amitriptyline overdose. She suffered a cardiac arrest followed by cardiovascular and neurological complications. Hypotension and lack of a pulse did not respond to treatment with high-dose sodium, but she stabilized following treatment with ILE. The prompt response from the emergency team guaranteed rapid intervention that may have influenced the successful results. Conclusions:Despite the frequency and severity of poisoning with tricyclic antidepressants, there is little consensus among physicians regarding patient management. This case showed the successful use of ILE as rescue therapy in a patient in cardiac arrest following amitriptyline overdose. However, the successful outcome obtained in this case is not a recommendation for the use of ILE as a first-line treatment for the management of patients with tricyclic antidepressant drug overdose. Controlled clinical studies are required to evaluate the safety and efficacy of ILE in the management of tricyclic antidepressant drug overdose.

Effect of lipid emulsion on neuropsychiatric drug-induced toxicity: A narrative review

“…3). Lipid emulsion significantly increased the GCS from 8.5 [4-11.75] (median [interquartile range: 25-75%]) to 14 [10][11][12][13][14][15] in 12 patients (Fig. 4, P = .0037).…”

Overdose medicamentosa pelo uso irracional de psicotrópicos: fluoxetina e amitriptilina

“…A amitriptilina é excessivamente lipofílica, tem elevada taxa de distribuição, em adultos, os sintomas com risco de vida ocorrem com doses que ultrapassem 100 mgs. Tem pacientes com quadros depressivos que consomem quatro vezes a dose letal de amitriptilina (3.700 mgs) (Angel-Isaza, et al, 2020). Para Qing et al (2022) a amitriptilina é um antidepressivo tricíclico clássico (TCA) com propriedades anticolinérgica e sedativa, cuja, concentração sanguínea letal precisa ainda não foi estabelecida.…”