Key messages

• Tricyclic antidepressants can be fatal in overdose owing to cardiac arrhythmias resulting from their proarrhythmic effect or profound hypotension resulting from their negative inotropic effect.

• Because tricyclic drugs delay gastric emptying, peak plasma levels occur within 2 to 8 h of a therapeutic dose, and peak overdose toxicity is usually seen within 6 h of ingestion.

• In cases seen within 2 h of ingestion, gastric lavage followed by 50 g of activated charcoal is indicated.

• All patients should be observed with ECG monitoring for at least 6 h after ingestion.

• If the patient is showing signs of worsening toxicity, has cardiovascular instablity or a wide QRS complex on the ECG, or is acidotic, sodium bicarbonate should be administered to maintain the arterial blood pH between 7.45 and 7.55.

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

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