• J Med Toxicol · Jun 2014

    Case Reports

    Prolonged use of intravenous lipid emulsion in a severe tricyclic antidepressant overdose.

    • Ravi Agarwala, Syed Zaki Ahmed, and Timothy J Wiegand.
    • Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA, ragarwal@wakehealth.edu.
    • J Med Toxicol. 2014 Jun 1;10(2):210-4.

    IntroductionIntravenous lipid emulsion (ILE) resuscitation is now frequently being used for severe overdoses due to lipophilic drugs. However, the optimal dose, duration, and safety are still unclear.Case ReportA patient with refractory cardiovascular collapse following an amitriptyline overdose was treated with ILE with initial improvement. Instability recurred after ILE discontinuation and lipid therapy was restarted, but high-dose treatment was complicated by severe lipemia. A low-dose infusion was instead used, and the patient did not experience further toxicity despite amitriptyline levels in the toxic range for 21 days. He survived to discharge without long-term sequelae.DiscussionA low-dose infusion of ILE was well tolerated and may have successfully prevented recurrent toxicity in a case of severe tricyclic antidepressant overdose.

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