Managing tricylic overdose?

Question

how would tricylic overdose be managed?

Answer 1

The treatment of tricyclic antidepressant overdose is generally similar to treatment for any poisoned patient. The initial treatment is to stabilize the vital signs. Typically, the patient has low blood pressure, and this must first be treated with intravenous fluids. If this is unsuccessful, specific agents called vasopressors can be used to maintain blood pressure. Life-threatening rhythms must be treated immediately. Establishing an airway for breathing, especially in the comatose individual, may require a breathing machine called a ventilator. If the patient is presenting with seizures, antiseizure medications such as diazepam, dilantin, and phenobarbital can be used.

Once the life-threatening emergencies are controlled, the key to treating tricyclic antidepressants overdose is to "decontaminate" the bowel. This means preventing further absorption of the drug through the stomach by using activated charcoal at frequent dosages. The activated charcoal binds to the antidepressant, thereby preventing its absorption. In addition, magnesium citrate can be given to speed up the removal of the drug from the gastrointestinal tract.

There is no real antidote for tricyclic antidepressants. Some physicians may try sodium bicarbonate to help block the drug's effect on the heart and the heart's electrical system.

The patient is admitted to either the intensive care unit or a bed where the heart can be monitored.

Answer 2

Initial treatment of an acute overdose includes gastric decontamination of the patient. This is achieved by administering activated charcoal which adsorbs the drug in the gastrointestinal tract either orally or via a nasogastric tube. Other decontamination methods such as stomach pumps, ipecac induced emesis, or whole bowel irrigation are not recommended in TCA poisoning.[23][24]

Symptomatic patients are usually monitored in an intensive care unit for a minimum of 12 hours, with close attention paid to maintenance of the airways, along with monitoring of blood pressure, arterial pH, and continuous ECG monitoring.[22] Supportive therapy is given if necessary, including respiratory assistance, maintenance of body temperature, and administration of sodium bicarbonate as an antidote. Sodium bicarbonate is given intravenously and it has been shown to be an effective treatment for resolving the metabolic acidosis and cardiovascular complications of TCA poisoning. If sodium bicarbonate therapy fails to improve cardiac symptoms, conventional antidysrhythmic drugs such as phenytoin and magnesium can be used to reverse any cardiac abnormalities. However, no benefit has been shown from lidocaine or other class 1a and 1c antiarrhythmic drugs; it appears they worsen the sodium channel blockade, slow conduction velocity, and depress contractility and should be avoided in TCA poisoning.[25] Hypotension is initially treated with fluids along with bicarbonate to reverse metabolic acidosis (if present), if the patient remains hypotensive despite fluids then further measures such as the administration of epinephrine, norepinephrine, or dopamine can be used to increase blood pressure.[25] Another potentially severe symptom is seizures; often seizures resolve without treatment but administration of a benzodiazepine or other anticonvulsive may be required for persistent muscular overactivity. There is no role for physostigmine in the treatment of tricyclic toxicity as it may increase cardiac toxicity and cause seizures.[22]

Tricyclic antidepressants are highly protein bound and have a large volume of distribution; therefore removal of these compounds from the blood with hemodialysis, hemoperfusion or other techniques are unlikely to be of any significant benefit.





PS its dangerous!!!

Answer 3

Used to be physostigmine. Now it is support for acidosis of the system and cardiac abnormality prevention. This is after attempts to rid the GI tract of any remnants by using charcoal or lavage.