Tricyclic Overdose
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Excerpt
To the Editor.— Referring to the letter "Tricyclic Overdose" (1980;244:1900), three comments are in order. First, while "the cause of death is primarily cardiovascular, generally due to arrhythmias or hypotension," other serious sequelae of tricyclic antidepressant (TCA) overdose that are independent from cardiovascular effects must be recognized and managed. Aspiration pneumonia, anticholinergic delirium, convulsions, and disturbed temperature regulation are among those that may occur. Neither the QRS duration nor accurate TCA serum levels will guarantee absence of these complications.
Second, just as there is wide variability in TCA serum level between persons with a constant oral TCA dose, so too is there variability in the myocardial TCA tissue level between persons with constant TCA serum levels.1 It is this myocardial tissue TCA level that is reflected in the lengthened QRS duration and that leads to the potentially lethal cardiovascular complications. Thus, while serum levels and myocardial tissue levels will
