Reactions 1453 - 25 May 2013

O SAmitriptyline/citalopram overdose

Various toxicities managed with soya oil emulsion:case report

A 34-year-old woman developed various toxicities followingan overdose with amitriptyline and citalopram. She wasmanaged with soya oil emulsion [Intralipid].

The woman overdosed on amitriptyline 5600mg andcitalopram 2400mg [route not stated]. She was foundunresponsive [time to reaction onset not stated], and she wastransferred to an emergency department. En route, shedeveloped a tonic-clonic seizure that was treated withdiazepam. She also experienced a cardiac arrest withventricular tachycardia, which responded to a precordialthump. She received fluids and epinephrine [adrenaline].Metabolic acidosis was seen with her blood gases, and herECG revealed bradycardia with a prolonged corrected QT-interval and a widened QRS-complex. She received sodiumbicarbonate, and she received continued supportive therapy inthe ICU. She experienced further episodes of tonic-clonicseizures and recurrent ventricular ectopics that led toprolonged runs of ventricular tachycardia.

The woman did not respond to magnesium and sodiumbicarbonate. Therefore, she was given soya oil emulsion. Hercondition improved markedly. No further seizures orarrhythmias were seen. She made a complete recovery.

Author comment: "We wish to highlight the potentialbenefits of using [soya oil emulsion], even in late stages ofsevere [tricyclic antidepressant] overdose".Nair A, et al. Management of near fatal mixed tricyclic antidepressant andselective serotonin reuptake inhibitor overdose with Intralipid 20% emulsion.Anaesthesia and Intensive Care 41: 264-265, No. 2, Mar 2013 - UnitedKingdom 803087284

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Reactions 25 May 2013 No. 14530114-9954/10/1453-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved