Tricyclic antidepressant poisoning Patient no 3 A 45 years old man is brought to the emergency by his wife. He has ingested some unknown medication in a suicide attempt. The patient is disoriented in time. His temperature is 1030 F, blood pressure is 120/85 mmHg, pulse is 100/ min (irregular) and respiration ate is 22/min. The skin is flushed and dry. Dilated pupils and muscle twitching are also noted on physical examination. ECG reveals prolonged QRS complexes. : Serum ALT : 24 U/L Arterial Blood Gases: normal acid base status. Name the drug which is the most likely cause of intoxication? Name the analytical technique used to confirm the presence of the drug in the blood. Tricyclic antidepressant (TCA) Liquid Chromatography-Mass Spectrometry (LC-MS) Ref No 3 Tricyclic antidepressant poisoning www.UpToDate.com 2015

Tricyclic Anti-Depressants (TCA) TCA are still an important cause of suicidal poisoning. Cardiovascular effects of TCA toxicity are important, which resemble an anti-arryhthmic drug like decreases conduction velocity, increase duration of repolarization, and prolonged absolute refractory periods Decreased level of consciousness or delirium may be present. Management is usually started on clinical presentation. For final diagnosis LC-MS is used. With this technique we can measure almost 8 TCA compound