Tricyclic antidepressant overdose: incidence of symptoms

Forty consecutively hospitalized patients who had overdosed primarily with a tricyclic antidepressant (TCA) were observed until discharge. The severity of the overdose was documented by serial measurements of plasma TCA levels. Nineteen of the patients became comatose, 16 required supportive respiration, and 2 died. Individual symptoms in the 13 patients having plasma TCA levels greater than 1,000 ng/ml are shown. Plasma TCA measurements more reliably define patients who are at risk for major medical complications following overdose than does the amount of drug ingested by history. In the absence of plasma measurements, a QRS duration of 100 msec or more on a routine ECG within the first 24 hours defined all patients with major TCA overdoses.

Tricyclic antidepressant overdoses in adolescent patients

Tricyclic antidepressant plasma levels were measured in nine hospitalized adolescent oversdose patients to define the medical seriousness of the drug ingestion. Seven out of nine of these patients ingested medication prescribed for treatment of their psychiatric symptoms. Indications for tricyclic therapy in adolescents are vague. The more frequent use of these drugs makes the potential for life-threatening ingestions relatively common. The amount of drug ingested is usually poorly documented. Plasma measurements are of value in assessing the efficacy of the various medical treatments of overdose patients. Two of these nine overdoses were medically serious as defined by plasma measurements. Supportive care with cardiac monitoring was adequate in one case; however, a fatality occurred in the other under what could be described as optimal patient management conditions.

Tricyclic antidepressant plasma levels and adverse effects after overdose

Forty patients ingesting tricyclic antidepressant (TAD) overdoses were studied as a pharmacologic model to determine whether total tricyclic antidepressant plasma levels correlated with major adverse effects and electrocardiographic findings. Maximum TAD plasma levels were higher in patients who died (p less than 0.025) or had cardiac arrest (p less than 0.02), needed respiratory support (p less than 0.005), were unconscious (p less than 0.02), had grand mal seizures (p less than 0.001), ventricular rate larger than or equal to 120/min (p less than 0.01), cardiac arrhythmia (p less than 0.05), QRS duration larger than or equal to 100 msec (p less than 0.001), or bundle branch block (p less than 0.05). TAD plasma levels correlated with the dose ingested by history (N = 29, r = 0.58, p less than 0.001). Measurement of total TAD (free and protein-bound) appears to correlate well with biologic response.

Psychiatric diagnosis and tricyclic plasma levels in 36 hospitalized overdose patients

Thirty-six hospitalized patients who were considered by emergency room physicians to have ingested medically serious tricyclic overdoses were studied. The purpose of the project was to determine if psychiatric diagnosis and associated psychiatric factors correlated with the severity of the overdose as defined by plasma drug levels. Medically serious overdoses were ingested by patients with alcoholism, primary affective disorder, undiagnosed psychiatric illness, and Briquet's syndrome. Prior psychiatric treatment, prior admissions, prior overdoses, or precipitating events did not correlate with the medical severity of the ingestion. Attempting to predict the individual medical severity of the overdose from psychiatric factors resulted in a dangerous underestimation of the risk of patients with Briquet's syndrome and an overprediction in the case of primary affective disorder.

Telemetric control of heart adaptation during automatic and free-fall parachute jumps

Telmetered heart rate recordings have been ovtaine from 17 parachutists (6 during automatic jumps) 9 Catecholamine (adrenaline and noradrenaline) concentrations have been measured in urine and plasma of six of these subjects. No difference appears between heart rates recorded in the two jumps at egress and at parachute deployment. On the other hand, higher heart rate values are recorded during automatic jumps during descent and at ground impace. The urine catecholamine analysis after jump shows a statistically significant increase in adrenaline and noradrenaline concentration. It is suggested that simulation of the orthosympathetic system is due to two facts; muscular work performed during jumping and the emotional stress which it involves. The importance of these two causes varies with the jump circumstances.