05 August 2023
: Case report 
Effective Treatment of Acute Tricyclic Antidepressant Poisoning with Cardiogenic Shock and Severe Rhabdomyolysis Using ECMO and CytoSorb® Adsorber
Management of emergency care, Educational Purpose (only if useful for a systematic review or synthesis)
Zakaria Zitoune
1BCDEF*, Luc Kugener 2EF, Joop Jonckheer 3EF, Katrien Lanckmans 4BCD, Philippe Hantson 5EF, Jacques Devriendt 6EF, Patrick M. Honore 1ABCDEF
DOI: 10.12659/AJCR.939884
Am J Case Rep 2023; 24:e939884
Table 1. Mechanism of toxicity and symptoms associated with tricyclic antidepressant poisoning.
| Mechanism of toxicity | Symptoms and signs |
|---|---|
| Presynaptic reuptake of noradrenaline and serotonin | Sympathomimetic, myoclonus, hyperreflexia, hyperthermia, serotonergic syndrome |
| Fast Na+ channel blockade (class I Vaughan-William’s classification) | Cardiac depression, decrease in cardiac output, hypotension, electrocardiogram changes (QRS duration, prolonged PR, bundle branch bloc, dysrhythmias), seizures |
| K+ channel efflux blockade | QTc prolongations with ventricular extra-systoles and torsade de pointe risk |
| Muscarinic receptors | Ileus, confusion, hypotension, irritability, seizures, coma, urinary retention, dry mouth and skin, pyrexia, acute angle glaucoma |
| Anti-histaminic effect | Sedation, coma |
| Alpha-adrenergic blockade | Sedation, hypotension, myosis, reflex tachycardia |
| GABA-A receptor blockade | Seizures, status epilepticus |