dothiepin-hydrochloride and Heart-Arrest

Tricyclic antidepressant (TCA) toxicity results predominantly from myocardial sodium-channel blockade. Subsequent ventricular dysrhythmias, myocardial depression, and hypotension cause cardiovascular collapse. Animal studies have demonstrated the effectiveness of intravenous lipid-emulsion in treating TCA cardiotoxicity.. We report a case of dothiepin (tricyclic antidepressant) overdose causing refractory cardiovascular collapse, which seemed to be successfully reversed with lipid-emulsion therapy (Intralipid(®); Fresenius, Cheshire, UK).. Lipid emulsions are a potentially novel therapy for reversing cardiotoxicity seen in TCA overdose. Research is required into the role of lipid emulsion in the management of poisoning by oral lipophilic agents.

Topics: Adult; Antidepressive Agents, Tricyclic; Dothiepin; Drug Overdose; Electrocardiography; Emulsions; Fat Emulsions, Intravenous; Female; Heart Arrest; Humans; Phospholipids; Soybean Oil

Hypotensive hemorrhagic necrosis of the basal ganglia and brainstem has only occasionally been described. Three such cases are reported. Cardiac arrest had occurred in all cases, and it took at least 1 hour to restore adequate circulation. The patients remained comatose for 2 days to 2 weeks until death. Persistent hypotension causing ischemia in the distribution of deep perforating arteries is considered to have been the key underlying mechanism. Hemorrhage is thought to have been caused by extravasation of red blood cells through damaged blood vessels.

Topics: Adult; Autopsy; Basal Ganglia Hemorrhage; Brain Stem; Cerebral Hemorrhage; Cerebral Palsy; Dothiepin; Drowning; Epilepsy; Extravasation of Diagnostic and Therapeutic Materials; Fatal Outcome; Heart Arrest; Hippocampus; Humans; Hypotension; Male; Middle Aged; Necrosis; Reperfusion Injury; Suicide

Twenty-seven patients with confirmed tricyclic antidepressant (TCA) self-poisoning were studied for 24 h following admission to hospital. Ten patients were judged to be severely poisoned on clinical grounds, whilst 14 patients had initial plasma levels above 1 mg l-1, indicating severe poisoning. Plasma levels were generally maximal on admission to hospital and fell quickly thereafter. Clinical and ECG data showed patients to be most at risk in the casualty department and three patients sustained cardiac arrest. Initial management must be speedy as these patients present with acute toxicity.

Topics: Adolescent; Adult; Antidepressive Agents, Tricyclic; Dothiepin; Electrocardiography; Female; Heart Arrest; Humans; Male; Middle Aged; Time Factors

Topics: Amitriptyline; Animals; Anthracenes; Antidepressive Agents, Tricyclic; Chick Embryo; Dothiepin; Heart Arrest; Imipramine; Lethal Dose 50; Maprotiline; Myocardial Contraction