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 2. Clinical features and treatment options for tricyclic antidepressant poisoning.
| Clinical features | Treatment |
|---|---|
| Respiratory depression | Intubation and mechanical ventilation |
| Acidosis and prolonged QRS | Sodium bicarbonate and alkalinization to reduce affinity of tricyclic antidepressants for sodium channels, targeting pH 7.45–7.55, increase sodium level to compete with Na+ channel blockade, with hypertonic saline bolus |
| Torsade de pointe, supraventricular and ventricular arrhythmia | Ensure normal levels of potassium, magnesium, lidocaine, electrical cardioversion |
| Hypotension | Vasopressors, intravenous fluid boluses |
| Seizures, hyperthermia | Benzodiazepines, general anesthesia, cooling, consider intralipid 20% emulsion |
| Life-threatening cardiac events and cardiac arrest | Acute life support resuscitation, consider intralipid 20% emulsion and extracorporeal membrane oxygenation (ECMO), anecdotical use of plasmapheresis or hemodialysis but not recommended |
| All adverse reactions | Activated charcoal to decrease further absorption of tricyclic antidepressants |