Reactions 1444 - 23 Mar 2013

O SAmitriptyline/citalopram/venlafaxineoverdose

Refractory haemodynamic instability: case reportA 53-year-old woman experienced haemodynamic

instability after an overdose of amitriptyline, citalopram andvenlafaxine.

The woman had previously attempted suicide, and wasreceiving venlafaxine [dosage and route not stated] andlorazepam for depressive disorder. Her husband brought herto an Emergency Room after he found her with a reduced levelof consciousness; she had superficial cuts to her left wrist andher Glasgow Coma Score was 3. Her respiratory rate was8 breaths/minute and arterial blood gas sampling indicatedrespiratory acidosis. Urine analysis identified benzodiazepinesand tricyclic antidepressants. Acute antidepressant poisoningwas considered the most likely diagnosis.

The woman was intubated and received haemodynamicresuscitation. Her HR dropped to 35 beats/minute despitereceiving isoprenaline; normal sinus rhythm was returnedfollowing administration of lipid emulsion. Toxicologicalanalysis determined toxic levels of amitriptyline, citalopram[dosages and routes not stated] and venlafaxine. She wastransferred to a ward after 10 days in an ICU.

Author comment: "In this case, we present a patient withcombined tricyclic antidepressants, selective serotoninreuptake inhibitor and serotonin and noradrenaline reuptakeinhibitor overdose. The haemodynamic instability caused bythe antidepressants proved to be refractory to extensiveionotropic support."Scholten HJ, et al. Intralipid as antidote for tricyclic antidepressants and SSRIs: Acase report. Anaesthesia and Intensive Care 40: 1076-1077, No. 6, Nov 2012 -Netherlands 803084822

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Reactions 23 Mar 2013 No. 14440114-9954/10/1444-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved