Abstract
Tricyclic overdose can be a medical emergency, and therapy with intravenous bicarbonate is not always successful in preventing cardiac toxicity or coma. Mortality in patients developing these complications is from 1% to 15%. Extracorporeal detoxification with sorbents has been used in treatment of patients with very high drug levels and declining clinical condition. Ten patients with serious drug overdose caused by tricyclics failed to respond quickly to standard therapy and were in stage 3-4 encephalopathy. Nine of these patients were on respirator support, 5 had hypotension, and 6 had QRS widening. Average level was 1,423 microg/L at presentation. Enteral activated charcoal and intravenous (IV) bicarbonate were initiated in the emergency room. The patients were treated for 3 to 4 hours with the Liver Dialysis Unit, a hemodiabsorption device using a cellulosic plate dialyzer and sorbent suspension as dialysate. Inflow and outflow blood levels indicated that the hemodetoxifier removed modest amounts of the tricyclics, metabolites, and other consumed drugs. The clinical improvement of the patients was dramatic, with patients reaching stage 0 or 1 encephalopathy during the treatment. Ventilator support was removed at the end of t...Continue Reading
References
Jan 1, 1976·Clinical Toxicology·T C Brown
Dec 10, 1977·Lancet·P CromeR Walkey
Apr 1, 1978·Lancet·R S PedersenK N Christensen
Nov 1, 1978·Archives of Disease in Childhood·P Crome, R A Braithwaite
Jan 1, 1990·Pharmacopsychiatry·M Kresse-Hermsdorf, B Müller-Oerlinghausen
Jun 1, 1988·The Journal of Pharmacy and Pharmacology·A A Shihab-EldeenG Kaufman
Jan 1, 1985·Journal of Toxicology. Clinical Toxicology·F J BaudP E Fournier
Aug 1, 1966·Biochemical Pharmacology·M H Bickel, M Baggiolini
Feb 1, 1984·Pharmacological Research Communications·L Della Corte, G P Sgaragli
May 1, 1984·Journal of Analytical Toxicology·J J Tasset, A J Pesce
Apr 1, 1983·Biochemical Pharmacology·J I JavaidJ M Davis
May 1, 1982·Journal of Toxicology. Clinical Toxicology·P R PentelC L DeVane
Jan 1, 1982·European Journal of Clinical Pharmacology·O L PedersenM Brinklø
May 1, 1981·Clinical Toxicology·P Pentel, L Sioris
May 1, 1981·Clinical Toxicology·M B NicotraM W Noall
May 1, 1994·Artificial Organs·S R Ash
Citations
Apr 28, 2007·Der Anaesthesist·S G SakkaE Hüttemann
Nov 2, 2004·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Osman DönmezRahmiye Canbek
Mar 5, 2008·Nephrology·Kenan BekKemal Baysal
Oct 10, 2007·Clinical Pharmacokinetics·Darren M Roberts, Nick A Buckley
Jan 8, 2013·Toxicology International·Esra OzayarHandan Gulec
Oct 31, 2014·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Marc GhannoumUNKNOWN EXTRIP workgroup
Nov 28, 2015·Clinical Kidney Journal·Julius J SchmidtJan T Kielstein
May 3, 2011·Advances in Chronic Kidney Disease·Marc GhannoumUNKNOWN EXTRIP workgroup
Jan 6, 2009·Lancet·Marinella AstutoAntonino Gullo
Apr 10, 2014·Seminars in Dialysis·Christopher YatesUNKNOWN EXTRIP workgroup
Dec 14, 2004·Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health·Paula S Derry
Oct 17, 2007·The Psychiatric Clinics of North America·Madeleine BeckerElisabeth J Shakin Kunkel
May 22, 2010·Human & Experimental Toxicology·Mehmet MutluEmbiya Dilber
Jan 14, 2009·Journal of Clinical Apheresis·Ebru KolsalVarim Numanoglu
Jul 17, 2007·Nature Materials·E L Starostin, G H M van der Heijden