engleski

Combined amytriptyline/propafenon overdose: a case report

Tricyclic antidepressant (TCA) are a commmon causes of drug overdose requiring treatmentin an intensive care unit. Regarding their toxic effect on central nervous and cardiovascular system, lethal outcome is not rare. A case of combined amitriptyline and propafenone overdose is described. Female, 33 years old was admitted to an intensive care unit 6 hours after ingestion 1 g of amitriptylin and 1.5 g of propafenone. Coma with oscillation in blood pressure from 170/114 to 120/70 mmHg and combined respiratory-metabolic acidosis (pH 7, 25) was determined. ECG showed sinus tachycardia 100bpm and right axis deviation of the QRS complex. Gastric lavage was performed and tablet particles were obtained in gastric content. Distrurbance of blood pressure and acidosis were observed and treated up to 14 hours postingestion with administration of intravenous fluids and sodium bicarbonate. Twenty four hours postingestion patient regained consciousness. Aced-base and ECG disturbances were still present. Prolongation of PQ interval (0.2 sec) and qrs complex (0.1 sec) was found. Thirty six hours postingestion all observed parameters became normal and patient was transferred to psychiatric unit. In TCA overdose, gastric lavage should be considered up to 12 hours postingestion because of the anticholinergic effect of TCA resulting in dalayed absorption. Right axis deviation and prolongation of QRS complex „d 0.1 sec in ECG are considered signs of severe toxicity (convulsions, cardial disrhythmias) and should be careffully monitored. Correction of acidosis in TCA overdose is of primary interest regarding its potential in prevention of cardial dysrhythmias. Expected additive cardiotoxic effect of propafenone was not observed probably due to adequate and timely treatment.

Poison Control Center; amytriptyline; propafenon; metabolic acidosis; ECG disturbances

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