[en] Poisoning with tricyclic antidepressants is common and can be life-threatening. The classic management is well known (chelating gastrointestinal, sodium bicarbonate, benzodiazepine, norepinephrine). A few years ago, a treatment with lipid emulsion, previously used in local anesthetics poisoning, has been successfully tested in tricyclic poisoning with cardiac arrest. We are currently unable to explain the exact mechanism of this treatment but it could have a place in the treatment of severe tricyclic poisoning with hemodynamic instability in addition to the conventional treatment.
Disciplines :
Cardiovascular & respiratory systems General & internal medicine
Author, co-author :
Berthe, G.; Service des Urgences CHU, Site Notre-Dame des Bruyères, Liège, 4000, Belgium
TONGLET, Martin ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des urgences
Bertrand, X.; Service des Urgences, CHR de la Citadelle, Liège, Belgium
Degesves, S.; Service des Urgences et du SMUR, CHR de la Citadelle, Liège, Belgium
Language :
English
Title :
Comment je traite... l'intoxication aux antidépresseurs tricycliques: Efficacité potentielle d'un traitement par émulsion lipidique
Alternative titles :
[en] How i treat... A poisoning with tricyclic antidepressants: Potential role of a treatment with lipid emulsion
Hoffman JR, Votey SR, Bayer M, et al. - Effect of hypertonic sodium bicarbonate in the treatment of moderate-to-severe cyclic antidepressant overdose. Am J Emerg Med, 1993, 11, 336-341.
Bruccoleri RE, Burns MM. - A literature review of the use of sodium bicarbonate for the treatment of QRS widening. J Med Toxicol, 2016, 12, 121-129.
Kiberd MB, Minor SF. - Lipid therapy for the treatment of a refractory amitriptyline overdose. CJEM, 2012, 14, 193-197.
American Society of Regional Anesthesia and Pain Medicine. - Checklist for treatment of local anesthetic systemic toxicity. En ligne: https://www.asra.com/advisory-guidelines/article/3/checklist-for-treatmentof-local-anesthetic-systemic-toxicity. Consulté le 23 mars 2016.
Turner-Lawrence DE, Kerns W. - Intravenous fat emulsion: a potential novel antidote. Toxicol Rev J Med Toxicol, 2008, 4, 109-114.
Rosenblat MA, Abel M, Fischer GW, et al. - Successful use of a 20 % lipid emulsion to rescucitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology, 2006, 105, 217-218.
Weinberg G, Picard J, Meek T, et al. - Lipid Registry. En ligne: http://www.lipidrescue.org. Consulté le 14 janvier 2016.
Young AC, Velez L, Kleinschmidt KC. - Intravenous fat emulsion therapy for the intentional sustainedrelease verapamil overdose. Rescucitation, 2009, 80, 591-593
Finn SDH, Uncles D, Willers J, et al. - Early treatment of a quetiapine and sertraline overdose with intralipid. Anesthesia, 2009, 64, 191-194
Engels P, Davidow J. - Intravenous fat emulsion to revers haemodynamic instability from inetntional amitriptyline overdose. Resuscitation, 2010, 1037-1039
Cao D, Heard K, Foran M, et al. - Intravenous lipid emulsion in the emergency department: a systematic review of recent literature. J Emerg Med, 2015, 48, 387-397.
