Published in:
01-01-2007 | Correspondence
Heart rate variability reveals risk of arrhythmias after intoxication with antidepressants
Authors:
Ina Djonlagic, Hasib Djonlagic, Thomas Kibbel, Sven Suefke, Christoph Dodt
Published in:
Intensive Care Medicine
|
Issue 1/2007
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Excerpt
We demonstrate here for the first time how monitoring of depressed heart rate variability (HRV) after intoxication with tricyclic antidepressants (TCA) may be a valuable marker of the cardiac autonomic nervous system function and can help identify patients who are at risk for developing cardiac arrhythmias. A 28-year-old man was admitted to the ICU at 3:20 a.m., 3 h after taking 9.2 g trimipramine and 7.35 g amitriptyline in a suicide attempt. His blood pressure was 140/70 mmHg and heart rate 105–135 bpm. He remained conscious and was breathing spontaneously with a respiration rate of 12–18/min, maintaining an oxygen saturation of 98%. The initial electrocardiogram showed widening of the QRS complex to more than 150 ms and a prolonged QTc interval of 522 ms, which immediately improved after intravenous administration of 100 ml 8.4% sodium bicarbonate and 2 mg physostigmine salicylate [
1]. Plasma levels were elevated at 831 ng/ml for trimipramine and 733 ng/ml for amitriptyline. Initial treatment included short-term intubation for a gastric lavage with 140 l fluid followed by multiple doses of activated charcoal, a single administration of magnesium sulfate, and intravenous fluid replacement. …