Tricyclic Antidepressant Overdose 67
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9. Special Medications:
-Activated charcoal 50 gm PO q4-6h, with sorbitol cathartic, until theophylline
level <20 mcg/mL. Maintain head-of-bed at 30-45 degrees to prevent
aspiration of charcoal.
-Charcoal hemoperfusion is indicated if the serum level is >60 mcg/mL or if
signs of neurotoxicity, seizure, coma are present.
-Seizure: Lorazepam 0.1 mg/kg IV at 2 mg/min; may repeat x 1 if seizures
continue.
10. Extras: ECG.
11. Labs: CBC, SMA 7&12, theophylline level now and in q6-8h; INR/PTT, liver
panel. UA.
Tricyclic Antidepressant Overdose
1. Admit to: Medical intensive care unit.
2. Diagnosis: TCA Overdose
3. Condition:
4. Vital Signs: Neurochecks q1h.
5. Activity: Bedrest.
6. Nursing: Continuous suicide observation. ECG monitoring, measure QRS
width hourly, inputs and outputs, aspiration and seizure precautions. Place
single-lumen nasogastric tube and lavage with 2 liters of normal saline if
recent ingestion.
7. Diet: NPO
8. IV Fluids: NS at 100-150 cc/hr.
9. Special Medications:
-Activated charcoal premixed with sorbitol 50 gm via NG tube q4-6h until
the TCA level decreases to therapeutic range. Maintain head-of-bed at
30-45 degree angle to prevent charcoal aspiration.
-Magnesium citrate 300 mL via nasogastric tube x 1 dose.
10. Cardiac Toxicity:
-If mechanical ventilation is necessary, hyperventilate to maintain pH 7.50-
7.55.
-Administer sodium bicarbonate 50-100 mEq (1-2 amps or 1-2 mEq/kg) IV
over 5-10 min, followed by infusion of sodium bicarbonate (2 amps in
D5W 1 L) at 100-150 cc/h. Adjust rate to maintain pH 7.50-7.55.
11.
Extras: ECG.
12.
Labs: Urine toxicology screen, serum TCA levels, liver panel, CBC,
SMA-7 and 12, UA.
