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

Abstract

Introduction

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.

Discussion

A low-dose infusion of ILE was well tolerated and may have successfully prevented recurrent toxicity in a case of severe tricyclic antidepressant overdose.

Keywords

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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