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Case 39
Published in Edward Schwarz, Tomos Richards, Cases of a Hollywood Doctor, 2019
Edward Schwarz, Tomos Richards
In this case, there is a high suspicion of a tricyclic antidepressant overdose due to the ECG changes and the seizure activity. This can cause antimuscarinic effects such as tachycardia, blurred vision, dry mouth and urinary retention. Patients may go on to develop hypotension and arrhythmias and so cardiac monitoring is essential. Life-threatening events tend to occur within the first 6 hours of ingestion.
Antidysrhythmic Drugs in Pediatrics
Published in Sam Kacew, Drug Toxicity and Metabolism in Pediatrics, 1990
Howard C. Mofenson, Thomas R. Caraccio, Kathleen Mimnagh, Peter Bruzzo
Phenytoin has been most useful in the pediatric population for the treatment of ventricular dysrhythmias, especially those which occur postoperatively or as a result of digitalis toxicity.47,138a, 139 Phenytoin in combination with propranolol is also beneficial in controlling ventricular tachycardia in patients with the prolonged QT interval syndrome.138a Its usefulness in reversing cardiac conduction abnormalities in tricyclic antidepressant overdose has not been confirmed.138b
A randomized trial comparing physostigmine vs lorazepam for treatment of antimuscarinic (anticholinergic) toxidrome
Published in Clinical Toxicology, 2021
George Sam Wang, Keith Baker, Patrick Ng, Gregory C. Janis, Jan Leonard, Rakesh D. Mistry, Kennon Heard
Physostigmine has not been widely adopted for treatment of antimuscarinic toxicity. In 2018, the NPDS annual review reported only 417 patients received physostigmine, while over 32,000 patients received benzodiazepines for various ingestions and exposures [1]. Concerns over the use of physostigmine stem from adverse events in the setting of tricyclic antidepressant overdose complicated by seizures and asystolic arrest, although the relationship of physostigmine in causing these events is heavily debated [7–8]. Another criticism of physostigmine is its short duration of action. However, a a clinical trial comparing physostigmine to benzodiazepine for treating antimuscarinic toxicity has not been performed. To determine the utility and safety of physostigmine, the objective of this study was to prospectively compare physostigmine to lorazepam for the treatment of antimuscarinic delirium and agitation.
Flecainide toxicity in renal failure
Published in Baylor University Medical Center Proceedings, 2018
Rogin Subedi, Ryan K. Dean, Arbind Chaudhary, Tamas Szombathy
Flecainide toxicity is treated in the same manner as a tricyclic antidepressant overdose. Sodium bicarbonate is administered either as a continuous infusion or intermittent boluses to maintain the pH between 7.5 and 7.55 to reverse the action of sodium channel blockade.11,14–16 Sodium bicarbonate provides an increased sodium load, because hyponatremia may increase the potential for flecainide toxicity. In addition, alkalization with sodium bicarbonate decreases the active ionized flecainide available for sodium channel inhibition.14 Intravenous fat emulsion therapy has also been shown to treat life-threatening ventricular arrhythmia caused by flecainide toxicity. It drives the offending drugs from the target tissue (site of toxicity) to the newly formed lipid sink.17,18
Systemic side effects of glaucoma medications
Published in Clinical and Experimental Optometry, 2022
Amirmohsen Arbabi, Xuan Bao, Wesam Shamseldin Shalaby, Reza Razeghinejad
Physostigmine, a reversible acetylcholinesterase inhibitor, is rarely used topically these days. Physostigmine causes accumulation of acetylcholine at synapses of muscarinic and nicotinic receptors and could cause seizure, hypersalivation, diaphoresis, nausea, vomiting, abdominal cramps, arrhythmia, and symptomatic bradycardia (Table 1).49 Physostigmine may not be used in tricyclic antidepressant overdose patients with evidence of QRS prolongation, as it may result in sudden cardiac arrest.49