Reactions 1119 - 16 Sep 2006

O SDesipramine overdose

Brugada syndrome: case reportA 44-year-old man developed Brugada syndrome after

taking an overdose of desipramine in a suicide attempt.The man, who had a history of depression, presented

7 hours after ingesting 30 desipramine pills [dosage not stated]and 20 clonazepam pills. His temperature was 36.0°C, his HRrate was 52 beats/min and his respiratory rate was 12 perminute. He had flushed skin, hypoactive bowel sounds and drymucus membranes. His initial ECG revealed first-degreeatrioventricular block, right bundle branch block morphology,sinus bradycardia, a prolonged QRS interval of 132ms, a PRinterval of 228ms, and a coved, downsloping ST-segmentelevation of > 2mm in V1-V2 with inverted T waves; thesefindings were consistent with Brugada type 1 ECG pattern.

The man received IV sodium bicarbonate. Within 5 hours,an ECG showed normalisation of his T wave inversions andright precordial ST-segment elevations; sinus bradycardia,first-degree atrioventricular block and right bundle branchblock morphology persisted. He was monitored for 48 hoursbefore being transferred to the psychiatry department fordepression management; he was asymptomatic for theremainder of his hospitalisation.

Author comment: Tricyclic antidepressants "are amongseveral drugs that can induce a type 1 Brugada ECG patterndue to myocardial sodium channel blocking properties".Akhtar M, et al. Brugada electrocardiographic pattern due to tricyclicantidepressant overdose. Journal of Electrocardiology 39: 336-339, No. 3, Jul 2006- USA 801044196

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Reactions 16 Sep 2006 No. 11190114-9954/10/1119-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved