FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 313:474-479 August 22, 1985 Number 8 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

There is a need for a rapid predictor of potential clinical severity to guide therapy in patients with an acute overdose of tricyclic antidepressant drugs. We performed a prospective study of 49 such patients to observe the associations among serum drug levels, maximal limb-lead QRS duration, and the incidence of seizures and ventricular arrhythmias. Patients were divided into two groups on the basis of maximal limb-lead QRS duration. Group A (13 patients) had a duration of less than 0.10 second, and Group B (36 patients) had a QRS duration of 0.10 second or longer. No seizures or ventricular arrhythmias occurred in Group A. In Group B there was a 34 per cent incidence of seizures and a 14 per cent incidence of ventricular arrhythmias. All patients survived. Serum drug levels failed to predict the risk of seizures or ventricular arrhythmias accurately. Seizures occurred at any QRS duration of 0.10 second or longer (P less than 0.05), but ventricular arrhythmias were seen only with a QRS duration of 0.16 second or longer (P less than 0.0005). We conclude that determination of the maximal limb-lead QRS duration predicts the risk of seizures and ventricular arrhythmias in acute overdose with tricyclic antidepressants. Serum drug levels are not of predictive value.

This article has been cited by other articles:

• Eyer, F., Stenzel, J., Schuster, T., Felgenhauer, N., Pfab, R., von Bary, C., Zilker, T. (2009). Risk assessment of severe tricyclic antidepressant overdose. Hum Exp Toxicol 28: 511-519 [Abstract]  
• Betten, D. P., Vohra, R. B., Cook, M. D., Matteucci, M. J., Clark, R. F. (2006). Antidote Use in the Critically Ill Poisoned Patient. J Intensive Care Med 21: 255-277 [Abstract]  
• Daly, F F S, Little, M, Murray, L (2006). A risk assessment based approach to the management of acute poisoning. Emerg. Med. J. 23: 396-399 [Abstract] [Full Text]  
• Greene, S L, Dargan, P I, Jones, A L (2005). Acute poisoning: understanding 90% of cases in a nutshell. Postgrad. Med. J. 81: 204-216 [Abstract] [Full Text]  
• Mokhlesi, B., Leikin, J. B., Murray, P., Corbridge, T. C. (2003). Adult Toxicology in Critical Care: Part II: Specific Poisonings. Chest 123: 897-922 [Full Text]  
• Riordan, M, Rylance, G, Berry, K (2002). Poisoning in children 3: Common medicines. Arch. Dis. Child. 87: 400-402 [Full Text]  
• McGuigan, M. E. (2001). Poisoning Potpourri. Pediatr. Rev. 22: 295-302 [Full Text]  
• Kerr, G W, McGuffie, A C, Wilkie, S (2001). Tricyclic antidepressant overdose: a review. Emerg. Med. J. 18: 236-241 [Abstract] [Full Text]  
• Cohen, H., Hoffman, R. S., Howland, M. A. (1997). Antidepressant Poisoning and Treatment: A Review and Case Illustration. Journal of Pharmacy Practice 10: 249-270 [Abstract]  
• Probst, B. D., Cetta, F. (1992). The Utility of a 12-Lead Electrocardiogram In Diagnosing a Suspected Antidepressant Overdose. CLIN PEDIATR 31: 622-625  
• Barone, J. A., Peppers, M. P. (1989). Therapeutic Drug Monitoring in Emergency Room Toxicology Settings. Journal of Pharmacy Practice 2: 347-356  
• Starmark, J.E., Heath, A. (1988). Severity Grading in Self-poisoning. Hum Exp Toxicol 7: 551-555 [Abstract]  
• Frommer, D. A., Kulig, K. W., Marx, J. A., Rumack, B. (1987). Tricyclic Antidepressant Overdose: A Review. JAMA 257: 521-526 [Abstract]  
• Brett, A. S., Rothschild, N., Gray, R., Perry, M. (1987). Predicting the Clinical Course in Intentional Drug Overdose: Implications for Use of the Intensive Care Unit. Arch Intern Med 147: 133-137 [Abstract]