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Extracorporeal Sorbent Detoxification Saves Lives After Tricyclic Overdosing
A DGReview of :"Treatment of severe tricyclic antidepressant overdose with extracorporeal sorbent detoxification"
Advances in Renal Replacement Therapy
04/09/2002
By David Loshak
Patients who overdose on tricyclic antidepressants can be successfully treated with extracorporeal sorbent detoxification, despite the high risk for ventricular arrhythmias, seizures and death.
Reporting dramatic clinical improvement after treatment, researchers in West Lafayette, Indiana, Los Angeles, California and Albuquerque, New Mexico, United States, say that the improvement may be due either to removal of free drug from the blood or to removal of drug metabolites.
Tricyclic overdose can be a medical emergency, intravenous bicarbonate does not always prevent cardiac toxicity or coma. Up to 15 percent of patients who develop these complications die.
The researchers report the use of extracorporeal detoxification with sorbents to treat 10 patients with very high drug levels and declining clinical condition caused by tricyclics. Average level was 1,423 µg per litre at presentation.
The patients had failed to respond quickly to standard therapy and were in stage 3-4 encephalopathy. Nine were on respirator support, five had hypotension and six had QRS widening, indicating cardiotoxicity.
The patients were given enteral activated charcoal and intravenous bicarbonate in the emergency room and then treated for three to four hours with the Liver Dialysis Unit (HemoCleanse, Inc.), a haemodiabsorption device. Inflow and outflow blood levels indicated that the hemodetoxifier removed modest amounts of the tricyclics, metabolites and other consumed drugs.
"The clinical improvement of the patients was dramatic", the researchers said. Patients reached stage 0 or 1 encephalopathy during treatment. Three patients who had not already developed pneumonia came off ventilator support at the end of treatment. Ventilator support for the other patients continued for up to 48 hours, because of pneumonia rather than mental status and the patients remained in the intensive care unit for one to seven days with an average of 4.8 days.
Adv Ren Replace Ther. 2002 Jan;9(1):31-41.
"Treatment of severe tricyclic antidepressant overdose with extracorporeal sorbent detoxification"
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