Management

1. There is no specific treatment for tricyclic antidepressant poisoning.

2. Patients require ECG monitoring during the first 24h and until ECG changes have disappeared for 12h.

3. Gastric elimination is worthwhile for 24h after ingestion since tricyclics slow gastric emptying.

4. Activated charcoal via a nasogastric tube will adsorb tricyclics remaining in the bowel.

5. Cardiac arrhythmias are more common if there is acidosis. Bicarbonate should be used to achieve an arterial pH of 7.5 urgently. If arrhythmias occur with no acidosis and fail to respond to treatment with amiodarone or phenytoin, bicarbonate (25-50ml 8.4% IV) may still be useful.

6. Seizures are best managed with benzodiazepines and phenytoin.

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