Der Anaesthesist

, Volume 60, Issue 6, pp 541–545

Amitriptylinbedingter Herz-Kreislauf-Stillstand

Behandlung mit Lipidemulsion
  • V. Huge
  • H. Baschnegger
  • P. Moehnle
  • A. Peraud
  • J. Briegel
Kasuistiken

Zusammenfassung

Es wird die erfolgreiche Behandlung einer Amitriptylinvergiftung mithilfe der repetitiven i.v.-Gabe einer Fettemulsion berichtet. Die initial gemessenen Amitriptylinserumspiegel lagen weit in einem Bereich, der laut Literatur oftmals als tödlich beschrieben wird. Die Patientin überlebte ohne neurologische Folgeschäden.

Schlüsselwörter

Kardiovaskuläre Erkrankungen Antidepressiva, trizyklische Überdosis Lipidemulsionen, intravenöse Kardiopulmonale Reanimation 

Amitriptyline-induced cardiac arrest

Treatment with fat emulsion

Abstract

A case of successful resuscitation of a patient with severe amitriptyline intoxication is reported. The measured amitriptyline serum levels far exceeded those assumed to be lethal according to the literature. Resuscitation was successful with the administration of intravenous fat emulsion and the patient recovered without any neurological sequelae.

Keywords

Cardiovascular diseases Antidepressive agents, tricyclic Overdose Fat emulsions, intravenous Cardiopulmonary resuscitation 

Literatur

  1. 1.
    Flanagan RJ (2008) Fatal toxicity of drugs used in psychiatry. Hum Psychopharmacol 23 (Suppl 1):43–51PubMedCrossRefGoogle Scholar
  2. 2.
    Henry JA, Alexander CA, Sener EK (1995) Relative mortality from overdose of antidepressants. BMJ 310:221–224PubMedGoogle Scholar
  3. 3.
    Brennan FJ (1980) Electrophysiologic effects of imipramine and doxepin on normal and depressed cardiac Purkinje fibers. Am J Cardiol 46:599–606PubMedCrossRefGoogle Scholar
  4. 4.
    Kolecki PF, Curry SC (1997) Poisoning by sodium channel blocking agents. Crit Care Clin 13:829–848PubMedCrossRefGoogle Scholar
  5. 5.
    Kerr GW, McGuffie AC, Wilkie S (2001) Tricyclic antidepressant overdose: a review. Emerg Med J 18:236–241PubMedCrossRefGoogle Scholar
  6. 6.
    McKinney PE, Rasmussen R (2003) Reversal of severe tricyclic antidepressant-induced cardiotoxicity with intravenous hypertonic saline solution. Ann Emerg Med 42:20–24PubMedCrossRefGoogle Scholar
  7. 7.
    Levitt MA, Sullivan JB Jr, Owens SM et al (1986) Amitriptyline plasma protein binding: effect of plasma pH and relevance to clinical overdose. Am J Emerg Med 4:121–125PubMedCrossRefGoogle Scholar
  8. 8.
    Leskiw U, Weinberg GL (2009) Lipid resuscitation for local anesthetic toxicity: is it really lifesaving? Curr Opin Anaesthesiol 22:667–671PubMedCrossRefGoogle Scholar
  9. 9.
    Jamaty C, Bailey B, Larocque A et al (2010) Lipid emulsions in the treatment of acute poisoning: a systematic review of human and animal studies. Clin Toxicol (Phila) 48:1–27Google Scholar
  10. 10.
    Musshoff F, Padosch S, Steinborn S, Madea B (2004) Fatal blood and tissue concentrations of more than 200 drugs. Forensic Sci Int 142:161–210PubMedCrossRefGoogle Scholar
  11. 11.
    Litz RJ, Roessel T, Heller AR, Stehr SN (2008) Reversal of central nervous system and cardiac toxicity after local anesthetic intoxication by lipid emulsion injection. Anesth Analg 106:1575–1577PubMedCrossRefGoogle Scholar
  12. 12.
    Ott K (2010) Lipidlösungen zur Therapie der Lokalanästhetikaintoxikation. Anaesthesist 59:575–583PubMedCrossRefGoogle Scholar
  13. 13.
    Abernathy CO, Lukacs L, Zimmerman HJ (1975) Toxicity of tricyclic antidepressants to isolated rat hepatocytes. Biochem Pharmacol 24:347–350PubMedCrossRefGoogle Scholar
  14. 14.
    Engels PT, Davidow JS (2010) Intravenous fat emulsion to reverse haemodynamic instability from intentional amitriptyline overdose. Resuscitation 81:1037–1039PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • V. Huge
    • 1
  • H. Baschnegger
    • 1
  • P. Moehnle
    • 1
  • A. Peraud
    • 2
  • J. Briegel
    • 1
  1. 1.Klinik für AnaesthesiologieKlinikum der Ludwig-Maximilians-UniversitätMünchenDeutschland
  2. 2.Klinik für NeurochirurgieKlinikum der Ludwig-Maximilians-UniversitätMünchenDeutschland

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