Reversal of severe tricyclic antidepressant-induced cardiotoxicity with intravenous hypertonic saline solution
Reversal of severe tricyclic antidepressant-induced cardiotoxicity with intravenous hypertonic saline solution
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DOI：
10.1067/mem.2003.233
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发表时间：
2003-07-01
影响因子：
6.2
通讯作者：
Rasmussen, R
中科院分区：
文献类型：
--
作者：
McKinney, PE;Rasmussen, R
一名29岁女性服用8 g去甲替林，因昏迷、低血压和QRS间期增宽到急诊科就诊。在插管、洗胃、过度通气和静脉注射生理盐水、碳酸氢钠推注（快速静脉推注）和大剂量去甲肾上腺素和多巴胺治疗后，她短暂好转，但在到达ICU时恶化。由于此时她的动脉pH值为碱性7.5，因此通过快速静脉输注（静脉推注）给予200 mL 7.5% NaCl形式的额外钠，以治疗低血压和QRS间期增宽伴心室异位。连续12导联ECG记录了她的QRS间期变窄，同时在高渗盐水输注3分钟内低血压改善。对于标准治疗无效的三环类抗抑郁药诱导的心脏毒性引起的宽复杂QRS波群和低血压，应考虑使用高渗盐溶液。
A 29-year-old woman ingested 8 g of nortriptyline and presented to the emergency department with coma, hypotension, and widened QRS interval. After intubation, gastric lavage, hyperventilation, and therapy with intravenous normal saline solution, sodium bicarbonate boluses (rapid intravenous push), and high doses of norepinephrine and dopamine, she transiently improved, only to deteriorate on arrival to the ICU. Because her arterial pH was alkalemic at 7.5 at this point, she was given additional sodium in the form of 200 mL of 7.5% NaCl by means of rapid intravenous infusion (intravenous push) to treat hypotension and widening QRS interval with ventricular ectopy. A continuous 12-lead ECG documented narrowing of her QRS interval with concomitant improvement of hypotension within 3 minutes of hypertonic saline solution infusion. Hypertonic saline solution should be considered for wide complex QRS and hypotension caused by tricyclic antidepressant-induced cardiotoxicity that is unresponsive to standard therapies.