Tricyclic antidepressant overdose

Last reviewed: 24 Aug 2022
Last updated: 04 Feb 2021

Summary

Definition

History and exam

Key diagnostic factors

  • change in mental status
  • tachycardia
  • hypotension
  • mydriasis
  • warm, dry, flushed skin
  • change in mental status
  • decreased or absent bowel sounds
  • urinary retention
  • ophthalmic signs
  • neurological signs
More key diagnostic factors

Other diagnostic factors

  • features of serotonin syndrome
Other diagnostic factors

Risk factors

  • history of¬†depression
  • obsessive-compulsive disorder
  • chronic pain
  • attention deficit hyperactivity disorders
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • sodium bicarbonate therapeutic trial
  • ABG
More 1st investigations to order

Investigations to consider

  • serum TCA concentrations
  • serum acetaminophen concentrations
  • serum salicylate concentrations
  • urine drug screen
More investigations to consider

Treatment algorithm

ACUTE

suspected or confirmed TCA overdose

Contributors

Authors

Alastair Newton, MB ChB, FCEM

Staff Specialist in Emergency Medicine

Emergency Department

The Prince Charles Hospital

Brisbane

Queensland

Australia

Disclosures

AN declares that he has no competing interests.

Acknowledgements

Dr Alastair Newton would like to gratefully acknowledge Dr Catherine Kelly and Dr Robert S. Hoffman, previous contributors to this topic. CK and RSH declare that they have no competing interests.

Peer reviewers

Edward Boyer, MD

Lecturer Pediatrics

The Children's Hospital

Boston

MA

Disclosures

EB declares that he has no competing interests.

Ruben Thanacoody, MD, FRCP(Edin)

Consultant Physician and Clinical Toxicologist

National Poisons Information Service (Newcastle)

Newcastle-upon-Tyne

UK

Disclosures

RT declares that he has no competing interests.

Laurie Prescott, MD, FRCP (Lond), FRCP (Edin), FFPM, FRSE

Emeritus Professor of Clinical Pharmacology

University of Edinburgh and Western General Hospital

Edinburgh

UK

Disclosures

LP declares that he has no competing interests.

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