Tricyclic antidepressant poisoning
Introduction
Introduction to tricyclic antidepressant poisoning This class of drugs has amitriptyline, imipramine, doxepine, etc., mainly used to combat depression, depression and inhibition. Antidepressants mainly act on the diencephalon (especially the hypothalamus) and the limbic system, and play an adjustment role in this part called the "emotional center." Tricyclic antidepressants can prevent the recovery of biogenic amines and produce antidepressant effects. Acute poisoning occurs in a suicide attempt to swallow a large number of drugs. A dose of 1.5 to 3.0 g can cause severe poisoning and death. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: coma, arrhythmia
Cause
Causes of tricyclic antidepressant poisoning
Cause:
Antidepressants mainly act on the diencephalon (especially the hypothalamus) and the limbic system, and play an adjustment role in this part called the "emotional center." Tricyclic antidepressants can prevent the recovery of norepinephrine and serotonin, and increase the synaptic gap alone to produce an antidepressant effect. It can also block a variety of transmitter receptors, causing many adverse reactions, such as blocking acetylcholine base M receptors, may cause dry mouth, blurred vision, sinus tachycardia, constipation, urinary retention, glaucoma aggravation, memory Dysfunction; block adrenergic a1 receptor, may enhance the antihypertensive effect of prazosin, orthostatic hypotension, dizziness, reflex tachycardia; stagnation histamine H1 receptor, may appear to strengthen central inhibitor Function, sedation, lethargy, lowering blood pressure; blocking dopamine D2 receptor, extrapyramidal symptoms, endocrine changes. Poisoning is mostly caused by accidental or excessive use.
Prevention
Tricyclic antidepressant poisoning prevention
When using this class of drugs, the dosage should be strictly controlled. When this class of drugs is combined with phenothiazines, phenytoin, aspirin, aminopyrine, isoniazid, scopolamine, etc., attention should be paid to the observation of side effects to avoid poisoning.
Complication
Tricyclic antidepressant poisoning complications Complications, coma, arrhythmia
Epilepsy, coma, arrhythmia and respiratory depression, and even death.
Symptom
Tricyclic antidepressant poisoning symptoms Common symptoms Myoclonic seizures, manic episodes, arrhythmia, coma
This class of drugs is less toxic, but has several side effects, such as manic state, extrapyramidal and autonomic dysfunction symptoms. Because of the anticholinergic effect of these drugs, it is often excited before the poisoning falls into a coma. Elevated, myoclonus or epileptic seizures, in terms of cardiovascular toxicity, blood pressure first rises and then decreases, myocardial damage, arrhythmia, sudden collapse or even cardiac arrest, severe death, arrhythmia to supraventricular For many reasons, due to the quinidine-like effect of this class of drugs, ventricular premature beats, ventricular tachycardia and even ventricular fibrillation can sometimes occur, accompanied by conduction block. In severe poisoning, the blood drug concentration can be as high as 10g/L. .
Examine
Examination of tricyclic antidepressant poisoning
Tricyclic antidepressant poisoning test items: urine routine, blood routine, liver function test, renal function test, blood biochemistry six tests, nervous system examination.
Six tests of blood biochemistry are preliminary tests on human blood conditions, including 1, alanine aminotransferase, creatinine, urea nitrogen, serum glucose, triglycerides, and total cholesterol.
Blood biochemical six check normal values:
Alanine aminotransferase ALT 35 IU/L 0~45
Creatinine CRE 1.9 mg/dL 0.5~1.5
Urea nitrogen BUN 14.6 mg/Dl 6.0~23.0
Serum glucose GLU 223 mg/dL 60~110
Triglyceride TG 217 mg/dL 50~200
Total cholesterol TCH 179 mg/dL 150~220
The concentration of tricyclic antidepressants can be determined in vomit, gastric juice, and blood.
Diagnosis
Diagnosis and identification of tricyclic antidepressant poisoning
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
Differential diagnosis
Differentiation from other types of antidepressant poisoning.
Baiyou solution
Overdose
Once taking a safe dose (80 mg) of Baiyoujie (fluoxetine hydrochloride), the most common manifestation is easy to nap and nausea. If you accidentally take Baiyoujie (fluoxetine hydrochloride), you should inform your doctor even if you are not feeling unwell.
Adverse reactions
A small number of patients may experience transient sleep disturbance or loss of appetite after taking the drug, but most of them do not need to stop the drug, and usually disappear in a short time. Very few patients need to be excited.
Depressed patients often have negative emotions and can have suicide attempts. Baiyoujie (fluoxetine hydrochloride) does not control the patient's behavior at the beginning of the medication, so it needs its guardian to see it. It is also possible for such patients to kill by taking more drugs, so it is necessary to strengthen the storage of drugs.
Very few people take allergic reactions after taking Bayoujie (fluoxetine hydrochloride), mainly rash and urticaria, but also fever, leukocytosis, joint pain, edema, shortness of breath, proteinuria and mild aminotransferase Increase. At this point, the drug should be discontinued and given antihistamines or steroids, and the symptoms can be completely eliminated. Other rare reactions include severe skin reactions, vasculitis, erythema multiforme, and serum disease.
