Clinical effects

Mild to moderate clinical effects of tricyclic antidepressant overdose are mainly anticholinergic and include dilated pupils, hallucinations, dry mouth, tachycardia, and urinary retention, as well as drowsiness, ataxia, and agitation. Metabolic acidosis and hypokalemia can occur. Severe poisoning may result in deep coma, hyper-reflexia, convulsions, hypotension, cardiac arrhythmias, respiratory depression, and pulmonary edema.

The patient may deteriorate over several hours following ingestion, with agitation, hallucinations, or confusion, giving way to deepening coma. During this phase, muscle tone is often increased with brisk tendon reflexes and extensor plantar reflexes, which may cause diagnostic problems unless this feature of tricyclic toxicity is known. Moderately dilated pupils and tachycardia are caused by the anticholinergic effects of the drug. However, although these features are useful in diagnosis, the anticholinergic effects are not responsible for serious toxicity.

The most dangerous problem is cardiac toxicity, which may be associated with widened QRS complexes (Bo.ehD.ert,a.D.d.,.Loyej.Oy,1.9.85.), ventricular arrhythmias, severe hypotension, metabolic acidosis, heart block, and asystole. Respiratory depression is also common in severe cases. Death is mainly due to hypotension and cardiac arrhythmias (P§ntel„.a.0d B.®n.owit?..,1986.).

Rare complications following tricyclic antidepressant overdose include rhabdomyolysis, myoglobinuria, hyperthermia, acute renal failure, and disseminated intravascular coagulation, usually secondary to intractable convulsions.

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