Reactions 1319 - 18 Sep 2010

O SDesipramine overdose

Fatal intoxication with Brugada-like ECG pattern:case report

A 58-year-old man died subsequent to an overdose ofdesipramine, taken with suicidal intention; a Brugada-likeECG pattern was found during investigation.

The man was found unresponsive and having repetitivemyoclonic seizures after ingesting 30 desipramine 50mgtablets [time to onset not stated]. He was transferred to theED after being intubated; his HR was 113 beats/min and hisBP 60/40mm Hg. Hypoactive bowel sounds and dilatedpupils were also noted. Laboratory findings revealedleucocytosis, renal insufficiency, and metabolic andrespiratory acidosis. Tricyclic antidepressants weredetected on blood toxicology. Subsequent ECG showedsinus tachycardia, PR lengthening, QRS widening, rightbundle branch block-like morphology with covered ST-segment elevation, and deep inverted T waves; the ST-segment was also elevated in inferior leads. Clinicalfindings indicated that he had severe tricyclicantidepressant intoxication.

The man was treated with sodium bicarbonate andactivated charcoal. Four hours later, his ECG hadcompletely normalised, but he continued to experiencemyoclonic jerks. Further neurological examinationsuggested severe hypoxic-ischaemic brain damage due toseizures. He was removed from life support and diedshortly thereafter.Sheikh M, et al. Simultaneous ST-segment elevation in inferior and precordialleads following ingestion of a lethal dose of desipramine: A novel Brugada-likeEKG pattern. Journal of Interventional Cardiac Electrophysiology 28: 35-38, Jun2010. Available from: URL: http://dx.doi.org/10.1007/s10840-009-9412-9 -USA 803037797

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Reactions 18 Sep 2010 No. 13190114-9954/10/1319-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved