Prolonged Use of Intravenous Lipid Emulsion in a Severe Tricyclic Antidepressant Overdose
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- Agarwala, R., Ahmed, S.Z. & Wiegand, T.J. J. Med. Toxicol. (2014) 10: 210. doi:10.1007/s13181-013-0353-4
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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.
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.
A low-dose infusion of ILE was well tolerated and may have successfully prevented recurrent toxicity in a case of severe tricyclic antidepressant overdose.