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Prolonged Use of Intravenous Lipid Emulsion in a Severe Tricyclic Antidepressant Overdose |
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| Authors: | Ravi Agarwala Syed Zaki Ahmed Timothy J Wiegand |
| Institution: | 1. Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA 4. Section on Critical Care, Department of Anesthesia, Wake Forest University Baptist Medical Center, Medical Center Drive, 9th Floor Janeway Tower, Winston-Salem, NC, 27157, USA 2. Northern Ontario School of Medicine, Thunder Bay, ON, Canada 3. University of Rochester School of Medicine, Rochester, NY, USA |
| Abstract: | IntroductionIntravenous 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 ReportA 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.DiscussionA 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 |
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