Late death in tricyclic antidepressant overdose revisited

Steven B. McAlphine, Joseph J. Calabro, Mel D. Robinson, Frederick M. Burkle

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


We report a late death follwoing the ingestion of amitriptyline. A 46-year-old woman presented to the emergency department with coma, hypotension, tachycardia, and a prolonged QRS interval after the ingestion of a large quality of Elavil®. She was managed with aggressive supportive care, multiple doses of oral charcoal, and charcoal hemoperfusion. The patient's ECG and hemodynamic status returned to normal within 24 hours. Despite an apparent total recovery, she suddenly sustained a cardiorespiratory arrest and died 33 hours after ECG normalization (at 57 hours after admission). This case brings into question the feasibility of ceasing ECG monitoring in tricyclic antidepressant overdoses once the ECG has stabilized, especially in patients with a history of chronic usage. A possible explanation for late sequelae is the myocardial cell binding and depressant effect of preexisting therapeutic TCA medication.

Original languageEnglish (US)
Pages (from-to)1349-1352
Number of pages4
JournalAnnals of emergency medicine
Issue number11
StatePublished - Nov 1986
Externally publishedYes


  • drug overdose, tricyclics, late death
  • overdose, tricyclics, late death
  • tricyclics, and late death
  • tricyclics, charcoal hemoperfusion
  • tricyclics, myocardial depressant effect

ASJC Scopus subject areas

  • Emergency Medicine


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