Poisoning, Tricyclic Antidepressant

Out of mind

Step 1: View clinicals

A 22 year old man is brought in by paramedics, after being found unconscious in a park. No history is available. His complete blood count, random capillary glucose, serum electrolytes, and renal and liver functions are all found to be normal.


Step 2: Order all relevant investigations

CT Brain

The CT scan of the brain is normal, with no evidence of hemorrhages, space occupying lesions, midline shift, or edema.

ECG

The rate is 120 bpm, with occasional premature ventricular complexes. The P waves, QRS complexes and T waves are of normal morphology, with a QRS duration of 80 ms. The PR and QT segments are isoelectric and of normal duration. There is mild right-axis deviation.

Arterial Blood Gases

On room air: PaO2: 90 mmHg (75-95) PCO2: 40 mmHg (35-45) SaO2 : 99% PH: 7.40 (7.35-7.45) HCO3: 24 mmol/L (24-32)

Toxicology Screen

Amphetamines, Acetaminophen, Benzodiazepines, Opiates, Cannabinoids, Methadone, Ethanol: not detected Tricyclic Antidepressants: positive


Step 3: Select appropriate management

Continuous ECG monitoring
IV NaHCO3
Gastric Lavage
Intubation & Ventilation


Score: ★★☆