Reactions 542 - 18 Mar 1995

SImipramine overdose

Hypotension treated with glucagon: case reportSevere hypotension associated with a massive imipramine

overdose was treated successfully with IV glucagon in a25-year-old woman.

The woman was admitted after ingesting 300 imipramine25mg tablets and an unknown quantity of temazepam andpropranolol. She had been found at home in cardiorespiratoryarrest and was intubated and ventilated by ambulance crew onher way to hospital. She was unconscious on arrival withconstricted pupils and was severely hypotensive (BP 71/30mmHg). Her plasma imipramine concentration was 3 mg/L (toxicconcentration 1 mg/L); toxicological screening for propranololwas negative.

Her treatment included IV polygeline, gastric lavage,activated charcoal, potassium supplements, and IV diazepamand phenytoin for seizures. An ECG showed a QRS interval of129 msec. As propranolol ingestion was suspected IMglucagon 50mg was given 50 minutes after admission;however, the woman failed to respond. Sodium bicarbonatewas then given, but her BP remained at 70/30mm Hg. An IVglucagon bolus (10mg) was then given and her BP immediatelyincreased to 110/70mm Hg. She was started on a 6-hourinfusion of glucagon 10mg and an isoprenaline infusion.

Two hours after the glucagon infusion was started, her ECGshowed a shortening of the QRS interval to 89 msec. Thewoman regained consciousness and was breathingspontaneously 24 hours after admission and she hadcompletely recovered after 4 days.

Author comment: ‘We suggest that glucagon administrationshould be considered more often in tricyclic antidepressantoverdose with severe hypotension unresponsive to volumeexpansion and sodium bicarbonate administration. Theshortening of the QRS interval in the present case also suggeststhat glucagon may have an antiarrhythmic effect in tricyclicantidepressant overdose.’Sener EK, et al. Response to glucagon in imipramine overdose. Journal ofToxicology - Clinical Toxicology 33: 51-53, Jan 1995 - England 800332810

1

Reactions 18 Mar 1995 No. 5420114-9954/10/0542-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved