Tricyclic Antidepressant Overdose

First Things First (assess for and treat the following)

  • ABCs are priority!
  • Mental status may deteriorate; pts may need intubation.
  • Cardiovascular monitoring for and treatment of life-threatening ventricular arrhythmias
  • Refractory hypotension is the most common cause of death in TCA overdose; IV fluid resuscitation should be initiated and adequate IV access obtained.
  • Activated charcoal should be administered for decontamination.
  • Alkalinization with sodium bicarbonate is a cornerstone of therapy, especially if QRS >100 ms and pt has wide complex tachycardia or hypotension.

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Last updated: May 16, 2010