Successful Treatment with Intravenous Lipid Emulsion of Severe Tricyclic Antidepressant Intoxication

Abstract

An overdose of amitriptyline has neurological and cardiovascular side effects (psychosis, lethargy, coma, hypotension, and dysrhythmia). A 19-year-old female patient was admitted to our emergency service after a suicide attempt by amitriptyline ingestion of unknown amount. Her follow-up demonstrated deteriorating consciousness and vital signs, she had a generalized tonic-clonic seizure, and her electrocardiogram (ECG) revealed QRS interval widening followed by a ventricular tachycardia (VT) attack. The patient was treated with intravenous (IV) diazepam (Diazem®) to control the epileptic seizure, IV lidocaine (Aritmal®) to stop the VT attack, and IV sodium bicarbonate due to QRS interval widening. The patient was given norepinephrine bitartrate (Steradine®) and dopamine hydrochloride (Dopamine®) due to low blood pressure. Intravenous lipid emulsion (ILE) therapy was started due to the uncontrolled rhythm and hypotension. Here, we present a case report of a comatose patient with dysrhythmia due to amitriptyline overdose who responds to ILE therapy. © 2021 Ondokuz Mayis Universitesi. All rights reserved.