Tricyclic antidepressant toxicity - Revision history

Danbot: Strip excess bold

2026-03-22T09:28:23Z

Strip excess bold

Danbot: Major update: bicarb protocol with pH goal, QRS/aVR thresholds, lipid emulsion, avoid phenytoin, charcoal timing, NE as first-line pressor, ECMO for refractory arrest, references with PMIDs

2026-03-21T19:50:06Z

Major update: bicarb protocol with pH goal, QRS/aVR thresholds, lipid emulsion, avoid phenytoin, charcoal timing, NE as first-line pressor, ECMO for refractory arrest, references with PMIDs

Show changes

Danbot: Add MedicationDose SMW entries for activated charcoal, sodium bicarbonate, lidocaine; doses verified against standard toxicology references

2026-03-20T17:36:06Z

Add MedicationDose SMW entries for activated charcoal, sodium bicarbonate, lidocaine; doses verified against standard toxicology references

← Older revision		Revision as of 17:36, 20 March 2026
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	*Consider discharging patients who remain asymptomatic after 6hr of observation		*Consider discharging patients who remain asymptomatic after 6hr of observation
	*Patients with decreased level of consciousness or seizures should be admitted to ICU		*Patients with decreased level of consciousness or seizures should be admitted to ICU


			==Medication Dosing==
			===GI Decontamination===
			*{{MedicationDose\|drug=Activated charcoal\|dose=1 g/kg x1\|route=PO\|context=GI decontamination\|indication=Tricyclic antidepressant toxicity\|population=Adult\|notes=If <1hr post-ingestion and patient is awake/cooperative}}

			===Cardiac Toxicity===
			*{{MedicationDose\|drug=Sodium bicarbonate\|dose=1-2 mEq/kg\|route=IV bolus\|context=Sodium channel blockade reversal\|indication=Tricyclic antidepressant toxicity\|population=Adult\|notes=For QRS >100ms; repeat until QRS <100ms or pH 7.50-7.55}}
			*{{MedicationDose\|drug=Lidocaine\|dose=1.5 mg/kg\|route=IV\|context=Ventricular dysrhythmias\|indication=Tricyclic antidepressant toxicity\|population=Adult\|notes=If sodium bicarbonate alone is ineffective}}

	==See Also==		==See Also==

Rossdonaldson1: /* Video */

2024-04-17T20:10:47Z

Video

← Older revision		Revision as of 20:10, 17 April 2024
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	*[[Antipsychotic Toxicity]]		*[[Antipsychotic Toxicity]]
	*[[Antidotes]]		*[[Antidotes]]

	~~==Video==~~
	~~{{#widget:YouTube\|id=rMVw4ImwNDo}}~~

	==References==		==References==
	<references/>		<references/>
	[[Category:Toxicology]]		[[Category:Toxicology]]

Elcatracho: /* See Also */

2022-01-03T10:17:12Z

Elcatracho: /* Clinical Features */

2020-11-21T20:31:04Z

Clinical Features

← Older revision		Revision as of 20:31, 21 November 2020
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	**Myoclonus, hyperreflexia		**Myoclonus, hyperreflexia
	**[[Serotonin Syndrome]] (only when used in combination with other serotonergic agents)		**[[Serotonin Syndrome]] (only when used in combination with other serotonergic agents)
			*Antagonism at GABA A receptors
			**[[Seizures]]

	==Differential Diagnosis==		==Differential Diagnosis==

SuperD: /* Background */

2020-01-20T19:40:52Z

Background

← Older revision		Revision as of 19:40, 20 January 2020
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	*Serious toxicity is almost always seen within 6hr of ingestion		*Serious toxicity is almost always seen within 6hr of ingestion
	*Coingestants that impair metabolism through cytochrome P450 often increase severity of toxicity		*Coingestants that impair metabolism through cytochrome P450 often increase severity of toxicity
	**[[Cocaine]] can produce the same sodium blockade effect and exacerbate a TCA overdose		**[[Cocaine]] can produce the same sodium blockade effect and exacerbate as TCA overdose

	===Ingestion amount===		===Ingestion amount===

Beren85: /* Intralipid */

2019-09-01T14:15:26Z

Intralipid

← Older revision		Revision as of 14:15, 1 September 2019
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	===[[Intralipid]]===		===[[Intralipid]]===
	1.5 mL/kg bolus		*1.5 mL/kg bolus over 2-3 minutes if life-threatening toxicity refractory to bicarbonate administration
			*May be repeated once in 5 minutes if no improvement, followed by an infusion of 0.25 ml/kg/min for 15-30 minutes

	==Disposition==		==Disposition==

ClaireLewis: /* Clinical Features */

2019-09-01T14:14:44Z

Clinical Features

← Older revision		Revision as of 14:14, 1 September 2019
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	==Clinical Features==		==Clinical Features==
	*Na Channel Blockade (2-6 hours post ingestion)		*Na Channel Blockade (2-6 hours post ingestion)
	**Negative inotropy, heart block, hypotension, ectopy		**Negative inotropy, [[heart block]], [[hypotension]], ectopy
	*~~Anti-Histamine~~ Effects		*Antihistamine Effects
	**Sedation, coma		**Sedation, [[coma]]
	*~~Anti-Muscarinic~~ Effects (early toxicity, within 2 hours)		*Antimuscarinic Effects (early toxicity, within 2 hours)
	**Central		**Central
	***Agitation, delirium, confusion, [[hallucinations]]		***[[Agitation]], [[delirium]], [[confusion]], [[hallucinations]]
	***Slurred speech, ataxia		***Slurred speech, [[ataxia]]
	***Sedation, coma		***Sedation, [[coma]]
	***[[Seizures]]		***[[Seizures]]
	**Peripheral		**Peripheral
	***Mydriasis, decreased secretions, dry skin, ileus, urinary retention		***Mydriasis, decreased secretions, dry skin, [[ileus]], [[urinary retention]]
	***Tachycardia, hyperthermia, hypertension		***[[Tachycardia]], [[hyperthermia]], [[hypertension]]
	*α<sub>1</sub> Receptor Blockade		*α<sub>1</sub> Receptor Blockade
	**Sedation, orthostatic hypotension, miosis		**Sedation, orthostatic hypotension, miosis
	*Inhibition of amine reuptake		*Inhibition of amine reuptake
	**Sympathomimetic effects		**[[Sympathomimetic]] effects
	**Myoclonus, hyperreflexia		**Myoclonus, hyperreflexia
	**[[Serotonin Syndrome]] (only when used in combination with other serotonergic agents)		**[[Serotonin Syndrome]] (only when used in combination with other serotonergic agents)

Beren85: /* Hypotension */

2019-09-01T14:13:18Z

Hypotension

← Older revision		Revision as of 14:13, 1 September 2019
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	*After repeat fluid boluses and with sodium load from NaHCO<sub>3</sub> norepinepherine should be the first line vasopressor		*After repeat fluid boluses and with sodium load from NaHCO<sub>3</sub> norepinepherine should be the first line vasopressor
	*ECMO is a successful adjunct for refractory hypotension after maximal therapy has failed		*ECMO is a successful adjunct for refractory hypotension after maximal therapy has failed
	*May also consider [[hypertonic saline\|hypertonic 3% saline]] for refractory hypotension		*May also consider 200 ml of [[hypertonic saline\|hypertonic 3% saline]] for refractory hypotension and ventricular dysrhythmias despite maximal alkalinization (pH > 7.55)

	===Dialysis===		===Dialysis===

← Older revision		Revision as of 10:17, 3 January 2022
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	*[[Beta-Blocker Toxicity]]		*[[Beta-Blocker Toxicity]]
	*[[Antipsychotic Toxicity]]		*[[Antipsychotic Toxicity]]
			*[[Antidotes]]

	==Video==		==Video==