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| wikitox:2.1.11.9.2.1_tricyclic_antidepressants [2025/04/13 04:27] – ↷ Links adapted because of a move operation 138.94.195.247 | wikitox:2.1.11.9.2.1_tricyclic_antidepressants [2025/07/18 00:06] (current) – [LATE COMPLICATIONS, PROGNOSIS - FOLLOW UP] kharris | ||
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| ===== LATE COMPLICATIONS, | ===== LATE COMPLICATIONS, | ||
| - | \\ Patients are medically fit for discharge if they have no symptoms or signs of toxicity (including no anticholinergic features such as tachycardia) and a normal ECG six hours following the overdose (especially if they have passed a charcoal stool). \\ \\ Patients who still have an isolated tachycardia generally should be kept in hospital and observed. As the usually cause is volume depletion, IV fluid to ensure adequate volume replacement should be given. \\ \\ Patients with a QRS complex equal to or greater than 100 milliseconds should be monitored until this has returned to normal. \\ \\ Reports of occasional late cardiac arrests have occurred in patients with persistently abnormal ECGs. Continued drug absorption or exposure may be the cause for late deterioration in this group and markedly delayed toxicity (> 24 hours) has only been reported in patients who did not receive gastrointestinal decontamination or, more recently, in modified release amitriptyline overdose. \\ \\ Antiholinergic delirium is relatively common post resolution of acute toxicity, and serotonin syndrome may be seen where a serotonergic drug has been co-inigested. \\ Neurological sequelae and other end organ injury may occur as a consequence of hypotension and cellular hypoxia in the setting of cardiac arrest or profound toxicity. They are not expected as a consequence of elevated drug levels per se, and are not seen post resolution of lesser toxicity. | + | \\ |
| + | Patients are medically fit for discharge if they have no symptoms or signs of toxicity (including no anticholinergic features such as tachycardia) and a normal ECG six hours following the overdose (especially if they have passed a charcoal stool).\\ | ||
| + | \\ | ||
| + | Patients who still have an isolated tachycardia generally should be kept in hospital and observed. As the usually cause is volume depletion, IV fluid to ensure adequate volume replacement should be given.\\ | ||
| + | \\ | ||
| + | Patients with a QRS complex equal to or greater than 100 milliseconds should be monitored until this has returned to normal.\\ | ||
| + | \\ | ||
| + | Reports of occasional late cardiac arrests have occurred in patients with persistently abnormal ECGs. Continued drug absorption or exposure may be the cause for late deterioration in this group and markedly delayed toxicity (> 24 hours) has only been reported in patients who did not receive gastrointestinal decontamination or, more recently, in modified release amitriptyline overdose.\\ | ||
| + | \\ | ||
| + | Antiholinergic delirium is relatively common post resolution of acute toxicity, and serotonin syndrome may be seen where a serotonergic drug has been co-inigested.\\ | ||
| + | Neurological sequelae and other end organ injury may occur as a consequence of hypotension and cellular hypoxia in the setting of cardiac arrest or profound toxicity. They are not expected as a consequence of elevated drug levels per se, and are not seen post resolution of lesser toxicity. | ||
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| + | ===== Educational Resources ===== | ||
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| + | [[https:// | ||
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| + | [[https:// | ||
| ===== REFERENCES ===== | ===== REFERENCES ===== | ||