Abstract
From 1/6/84-6/6/84, 49 acute overdoses involving tricyclic antidepressants (TCA's) were followed for seizures and ventricular arrhythmias. Arrhythmias were defined as: idioventricular rhythms, ventricular tachycardia, ventricular fibrillation, prolonged bigeminy or trigeminy, and asystole. Patients were divided into two groups. Group 1 (N=13): QRS < 0.1 seconds. Group 2 (N=36): QRS ≥ 0.1 seconds. Results in Group 1: 100% survival, 0% seizures or arrhythmias. Mean TCA concentration was 792 ± 621 ng/ml (range 351-2677 ng/ml). Average age: 34.4 ± 19.7 yrs. Results in Group 2: 100% survival, 33% seizures, 13.97, ventricular arrhythmias. Mean TCA concentration 1473 ± 967 ng/ml. Average age: 33.8 ± 12.4 yrs. All seizures or arrhythmias occurred within 6 hours of the overdose and resolved by 24 hours. TCA concentration did not correlate with QRS duration, symptoms, or prognosis. A QRS duration ≥ 0.1 seconds did correlate with seizures (p < 0.05), while a QRS ≥ 0.16 seconds correlated with ventricular arrhythmias (p < 0.0005).
We conclude, in contrast to earlier reports, that: a) a QRS ≥ 0.1 seconds (and not peak TCA levels) identifies patients at high risk for seizures, b) similarly, a QRS ≥ 0.16 seconds identifies patients at high risk for ventricular arrhythmias, c) a QRS < 0.1 seconds effectively excludes patients from risk of seizures and/or ventricular arrhythmias, and d) seizures and/or ventricular arrhythmias occur within 6 hours and abate by 24 hours of an acute TCA overdose.
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Boehnert, M., Lovejoy, F. 168 QRS vs. LEVEL IN PREDICTING CLINICAL SEVERITY IN ACUTE TCA OVERDOSE. Pediatr Res 19, 138 (1985). https://doi.org/10.1203/00006450-198504000-00198
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DOI: https://doi.org/10.1203/00006450-198504000-00198
