Recovery of cyclic depressants with gastric lavage. J Emerg Med 1989 ; 7 : 373 –7. [doi.org]

In view of the paucity of evidence that gastric lavage removes a significant amount of drug and the risk of complications associated with the procedure, the routine use of gastric lavage in the management of patients with TCA poisoning is not appropriate [ncbi.nlm.nih.gov]

Arrhythmias, including VF and torsade Central nervous system features Drowsiness Coma Seizures Pyramidal signs and rigidity Ophthalmoplegia Anticholinergic features Dry mouth Blurred vision Dilated pupils Urinary retention Ileus, absent bowel sounds High fever [derangedphysiology.com]

sudden high fever with jaundice, priapism (condition marked by persistent erections), swollen lymph nodes and respiratory distress. [drugs.nmihi.com]

A tricyclic overdose may cause: Hallucinations Drowsiness Enlarged pupils Fever Irregular heartbeat Severe dizziness Severe muscle stiffness or weakness Restlessness or agitation Breathing problems, respiratory failure Vomiting Convulsions Coma A TCA [healthyplace.com]

[…] small pupils Hypothermia, bradycardia, respiratory arrest, acute lung injury Airway protection, IPPV naloxone Salicylates Aspirin Altered mental status, respiratory alkalosis, metabolic acidosis, tinnitus, hyperpnoea, tachycardia, sweating Low-grade fever [academic.oup.com]

Generally anticholinergic effects do not cause serious clinical problems but cases of toxic megacolon and intestinal perforation have been described. 11, 12 By impairing sweating heat dissipation is reduced and this can result in a fever, especially if [doi.org]

In patients who can not tolerate the volume of fluid associated with an infusion (eg, those with congestive heart failure, renal impairment, or end-stage renal disease), use of repeated boluses may be preferable. [emedicine.medscape.com]

The use of imipramine in depressed patients with congestive heart failure. JAMA 1983 ; 250: 1997 – 2001 [Crossref], [PubMed], [Web of Science ], [Google Scholar] ). [doi.org]

Hypertension followed by hypotension RESP: ARDS, aspiration pneumonitis CNS: Seizures, CNS depression, drowsiness, coma, extra pyramidal effects GI/GU: Decreased or absent bowel sounds, urinary retention OTHER: Metabolic acidosis, hyper-/hypothermia Decontamination [calsprogram.org]

Successful use of therapeutic hypothermia after cardiac arrest due to amitryptiline and venelafaxine intoxication. Ther hypothermia Temp manag. 2015;5(2):104–9. View Article PubMed Google Scholar Eken C. [bmcresnotes.biomedcentral.com]

defaecation, muscle weakness, bronchorrhoea Bradycardia, dilated or constricted pupils, seizures, respiratory failure, paralysis Airway protection and IPPV, atropine, pralidoxime Opioid Heroin, morphine CNS and respiratory depression, small pupils Hypothermia [academic.oup.com]

Doxepin cream is used for relief of localized pain and for itching. All authors Alan D. Woolf M.P.H. M.D., Andrew R. Erdman M.D., Lewis S. Nelson M.D., E. Martin Caravati M.P.H. M.D., Daniel J. Cobaugh Pharm.D., Lisa L. Booze Pharm.D., Paul M. [doi.org]

The overall frequency of admission hypotension (systolic BP less than 95 mmHg) was 34% (22 of 64 patients). [ncbi.nlm.nih.gov]

K Channel Blockade QTC Prolongation NE & Serotonin Reuptake Inhibition Initial hypertension quickly followed by hypotension Na Channel Blockade QRS Prolongation Hypotension — depresses myocardial contractility Ventricular dysrhythmias Brugada-like findings [em3.org.uk]

ECG abnormalities, with the exception of sinus tachycardia and infrequent PVC's were associated with a severely depressed sensorium and disappeared with neurological improvement, usually in 24 h. [ncbi.nlm.nih.gov]

K Channel Blockade QTC Prolongation NE & Serotonin Reuptake Inhibition Initial hypertension quickly followed by hypotension Na Channel Blockade QRS Prolongation Hypotension — depresses myocardial contractility Ventricular dysrhythmias Brugada-like findings [em3.org.uk]

(J Emerg Med 1995;13(6):781-5) This one is from Bryan Hayes) Pharmacologic Effects of TCAs K Channel Blockade QTC Prolongation NE & Serotonin Reuptake Inhibition Initial hypertension quickly followed by hypotension Na Channel Blockade QRS Prolongation [emcrit.org]

Hypertension followed by hypotension RESP: ARDS, aspiration pneumonitis CNS: Seizures, CNS depression, drowsiness, coma, extra pyramidal effects GI/GU: Decreased or absent bowel sounds, urinary retention OTHER: Metabolic acidosis, hyper-/hypothermia Decontamination [calsprogram.org]

Amphetamine, Methamphetamine, Cocaine, Diet aids, Nasal decongestants, Bath Salts Stimulant Signs and symptoms Restlessness, Agitation, Incessant talking, insomnia, Anorexia, dilated pupils, tachycardia, tachypnea, hypertension or hypotension, paranoia [quizlet.com]

Vasodilators are first-line therapy for treating amphetamine-induced hypertension E. Wide-complex tachydysrhythmias should be treated initially with sodium bicarbonate Question 2. [foamcast.org]

Symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. [en.wikipedia.org]

Clinical Effects HEENT: Nystagmus, blurred vision, dry mouth, flushing, mydriasis CV: Widening of the QRS interval is the most commonly used marker of toxicity. A QRS interval 0.1 second is indicative of potential toxicity. [calsprogram.org]

vision Dilated pupils Urinary retention Ileus, absent bowel sounds High fever, or inability to regulate temperature Anhidrosis Delirium Metabolic features Metabolic acidosis Respiratory acidosis Management of tricyclic overdose Decontamination Activated [derangedphysiology.com]

Symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. [1] If symptoms have not occurred within six hours of exposure they are unlikely to occur. [2] TCA overdose [ipfs.io]

[…] gastrointestinal distress, diarrhea, respiratory depression, apnea, seizures, coma Anticholinergic Drug Examples Atropine, Scopolamine, Antihistamines, Antipsychotics, Anticholinergic Signs and Symptoms Dry, Flushed skin, hyperthermia, dilated pupils, blurred [quizlet.com]

More severe complications include hypotension, cardiac rhythm disturbances, hallucinations, and seizures. [en.wikipedia.org]

Seizures and aspiration pneumonia may occur regardless of initial BP. [ncbi.nlm.nih.gov]

No seizures or ventricular arrhythmias occurred in Group A. In Group B there was a 34 per cent incidence of seizures and a 14 per cent incidence of ventricular arrhythmias. All patients survived. [dx.doi.org]

Symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. [en.wikipedia.org]

The patient started with a confused mental state and decreased to a GCS of eight, potentially indicating the need for an advanced airway. [ems1.com]

Symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. [1] If symptoms have not occurred within six hours of exposure they are unlikely to occur. [2] TCA overdose [ipfs.io]

[…] mydriasis agitation and seizures, hyperthermia Sedative/hypnotics Drug Examples Phenobarbital, diazepam AKA Valium, thiopental, midazolam aka versed, lorazepam Sedative/hypnotics Signs and symptoms Drowsiness, disinhibition, ataxia, slurred speech, mental confusion [quizlet.com]

Cardiovascular Tachycardia Hypotension (cause of mortality) Arrhythmia-SVT/VT VT in 4% of cases approx) CNS Ataxia Nystagmus Sedation, coma Seizures (about 5% of cases) Amblyopia Anticholinergic Mydriasis Dry mouth Absent bowel sounds Urinary retention Agitation [emed.ie]

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. [en.wikipedia.org]

Labored breathing, low blood pressure, shock, enlarged pupils, coma, agitation, hallucinations, muscle rigidity, convulsions, and agonal breathing were also reported. [aa400415.wordpress.com]

Amphetamine, Methamphetamine, Cocaine, Diet aids, Nasal decongestants, Bath Salts Stimulant Signs and symptoms Restlessness, Agitation, Incessant talking, insomnia, Anorexia, dilated pupils, tachycardia, tachypnea, hypertension or hypotension, paranoia [quizlet.com]

GCS was 9 (E2M5V2) although she appeared agitated with bilaterally dilated pupils. There was no external evidence of injury. [icmcasesummaries.com]

The authors describe a patient with tricyclic antidepressant overdose who presented with altered mental status and whose serial ECG changes played a significant role in diagnosing and predicting the impending cardiovascular toxicity. [ncbi.nlm.nih.gov]

Serotonin syndrome consists of a triad of altered mental status, neuromuscular hyperactivity, and autonomic instability, similar in presentation to neuroleptic malignant syndrome—hyperpyrexia, acidosis, arrythmias, and rhabdomyolysis are seen. [academic.oup.com]

A 24-year-old man presents to the ED via the police because of altered mental status and violent behavior. The patient reportedly had been on a drug binge, using amphetamines and cocaine for the last 2 days. [foamcast.org]

Imipramine and electrocardiographic abnormalities in hyperactive children. Am J Psychiatry 1975 ; 132: 542 – 545 ). [doi.org]

"Attention-deficit/hyperactivity disorder (ADHD) as a noradrenergic disorder". Biol Psychiatry. 46 (9): 1234–42. doi : 10.1016/S0006-3223(99)00192-4. PMID 10560028. Popper C (1997). [wikidoc.org]

[…] clinical use. [1] Despite the increasing popularity of the selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression, CAs continue to play an important role in the treatment of enuresis, obsessive-compulsive disorder, attention deficit hyperactivity [emedicine.medscape.com]

In those who have a wide QRS complex ( 100 ms) sodium bicarbonate is recommended. If seizures occur benzodiazepines should be given. In those with low blood pressure intravenous fluids and norepinephrine may be used. [en.wikipedia.org]

In those who have a wide QRS complex ( 100 ms ) sodium bicarbonate is recommended. [ipfs.io]

There are wide QRS complexes with rapid ventricular rate ( Ventricular tachcardia ): Toxicity Tricyclics have a narrow therapeutic index, i.e. the therapeutic dose is close to the toxic dose. [wikidoc.org]

Torsade de pointes occurs uncommonly. Hypotension results from a combination of reduced myocardial contractility and reduced systemic vascular resistance due to alpha-adrenergic blockade. [ncbi.nlm.nih.gov]

Doxepin-induced torsade de pointes tachycardia. Ann Intern Med 2001; 135: 384–5 PubMed Google Scholar 43. Davison ET. Amitriptyline-induced torsade de pointes: successful therapy with atrial pacing. [doi.org]

There may also be a ventricular arrythmia, particularly polymorphic ventricular tachycardia, specifically Torsades de Pointes. This should be treated typically with a magnesium sulfate infusion of 2 g over two minutes. [ems1.com]

Amitriptyline-induced torsade de pointes: successful therapy with atrial pacing. J Electrocardiol 1985; 18: 299–301 PubMed CrossRef Google Scholar 52. Knudsen K, Abrahamsson J. [dx.doi.org]

Serial electrocardiogram changes in acute tricyclic antidepressant overdoses. Crit Care Med 1997; 25: 1721–6 PubMed CrossRef Google Scholar 36. Shannon MW. Duration of QRS disturbances after severe tricyclic antidepressant intoxication. [doi.org]

Serial electrocardiogram changes in acute tricyclic antidepressant overdoses. Crit Care Med 1997; 25: 1721–6 PubMed CrossRef Google Scholar 11. Shannon MW. Duration of QRS disturbances after severe tricyclic antidepressant intoxication. [dx.doi.org]

Electrocardiogram changes are common and precede the development of hypotension and neurological deterioration, therefore close watch on ECG monitoring is strongly recommended in the patients of TCAs poisoning. References 1. [mjdrdypu.org]