![]() Electrocardiogram (ECG) abnormalities are frequent and a wide variety of cardiac dysrhythmias can occur, the most common being sinus tachycardia and intraventricular conduction delay resulting in prolongation of the QRS complex and the PR/ QT intervals. More severe complications include hypotension, cardiac rhythm disturbances, hallucinations, and seizures. ![]() Initial or mild symptoms typically develop within 2 hours and include tachycardia, drowsiness, a dry mouth, nausea and vomiting, urinary retention, confusion, agitation, and headache. The peripheral autonomic nervous system, central nervous system and the heart are the main systems that are affected following overdose. ![]() An overdose from TCAs was first reported in 1959. In the United Kingdom they resulted in about 270 deaths a year. In the United States in 2004 there were more than 12,000 cases. In the early 2000s TCAs were one of the most common cause of poisoning. The use of intravenous lipid emulsion may also be tried. In those with low blood pressure intravenous fluids and norepinephrine may be used. If seizures occur benzodiazepines should be given. In those who have a wide QRS complex ( > 100 ms) sodium bicarbonate is recommended. In overdose activated charcoal is often recommended. An electrocardiogram (ECG) should be included in the assessment when there is concern of an overdose. In small children one or two pills can be fatal. Most are non-toxic at less than 5 mg/kg except for desipramine, nortriptyline, and trimipramine, which are generally non-toxic at less than 2.5 mg/kg. The toxic dose depends on the specific TCA. TCA overdose may occur by accident or purposefully in an attempt to cause death. If symptoms have not occurred within six hours of exposure they are unlikely to occur. Symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. Tricyclic antidepressant overdose is poisoning caused by excessive medication of the tricyclic antidepressant (TCA) type. Supportive, sodium bicarbonate, lipid emulsion TCA poisoning, TCA overdose, TCA toxicityĬhemical structure of the tricyclic antidepressant amitriptylineĮlevated body temperature, large pupils, irregular heart beat, seizures Medical condition Tricyclic anti-depressant overdose
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