Journal of Medical Toxicology

, Volume 10, Issue 2, pp 210–214

Prolonged Use of Intravenous Lipid Emulsion in a Severe Tricyclic Antidepressant Overdose

  • Ravi Agarwala
  • Syed Zaki Ahmed
  • Timothy J. Wiegand
Toxicology Observation

DOI: 10.1007/s13181-013-0353-4

Cite this article as:
Agarwala, R., Ahmed, S.Z. & Wiegand, T.J. J. Med. Toxicol. (2014) 10: 210. doi:10.1007/s13181-013-0353-4



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.

Case Report

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.


Poisoning Antidepressive agents Tricyclic Fat emulsions Intravenous Antidotes 

Copyright information

© American College of Medical Toxicology 2013

Authors and Affiliations

  • Ravi Agarwala
    • 1
    • 4
  • Syed Zaki Ahmed
    • 2
  • Timothy J. Wiegand
    • 3
  1. 1.Wake Forest School of MedicineWinston-SalemUSA
  2. 2.Northern Ontario School of MedicineThunder BayCanada
  3. 3.University of Rochester School of MedicineRochesterUSA
  4. 4.Section on Critical Care, Department of AnesthesiaWake Forest University Baptist Medical CenterWinston-SalemUSA

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