Ecg Changes in Pure Imipramine Overdose as Function of Plasma Level*

1978 ◽  
Vol 23 (8) ◽  
pp. 573-577 ◽  
Author(s):  
K. Reed ◽  
H.R. Mckim
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Plasma Level ◽  
Plasma Levels ◽  
Tricyclic Antidepressants ◽  
Lethal Effect ◽  
Acute Management ◽  
Relative Toxicity ◽  
Ecg Changes ◽  
Therapeutic Doses

ECG changes occur with therapeutic doses of tricyclic antidepressants and cardiovascular conduction alteration is the lethal effect in overdoses on these drugs. These ECG changes depend on the plasma level and metabolism of the particular antidepressant. Information about the relative toxicity and metabolism characteristics can be obtained by studying overdoses if the attempt simply involves one tricyclic and no other drug ingestion. Such a case report involving a known quantity of imipramine is presented. The early toxic signs leading to cardiac arrest and the recovery from coma are discussed. The ECG along with corresponding plasma levels of imipramine and its metabolite desmethylimipramine are given as a function of time after ingestion. The relative toxicity of these metabolites and the use of anticholinesterase in the acute management is considered.

Clozapine - on the Level?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S.P. Natarajan ◽  
C. Lewin
Keyword(s):  
Plasma Level ◽  
Plasma Levels ◽  
Patient Monitoring ◽  
High Plasma ◽  
Once Daily ◽  
Significant Evidence ◽  
Legal Perspective ◽  
Patient Monitoring System ◽  
Therapeutic Doses ◽  
Trough Plasma

Aim:To discover whether clozapine is being prescribed and monitored according to accepted guidelines.Method:Sample size 30 with a diagnosis of Schizophrenia generated from a list of patients attending clozapine clinic. Clozapine levels were done prospectively from December 07 to March 08.Results:Of 30 patients, 73% were male and 27% female. 57% were prescribed >450 mg once daily and 50% had trough plasma levels >0.60mg/l. Only 21% were within the therapeutic range (as recommended by Clozapine Patient Monitoring System) 0.35-0.60 mg/l. 29% of patients had a plasma level < 0.35 mg/l. Only 10% had plasma levels checked within the last 6 months.Among 8 patients taking more than 600 mg of clozapine, 5 had an anticonvulsant prescribed prophylactically. among 14 patients with a plasma level >0.60 mg/l, only five had an anticonvulsant co-prescribed.Discussion:The outcome of this audit has wide implications from a medico-legal perspective. There is significant evidence implicating clozapine in the development of metabolic syndrome as well as potentially serious side effects including seizures. It is important that clozapine plasma levels are checked when therapeutic doses (Maudsley guidance: 450mg once daily) are reached and that anticonvulsant prophylaxis is considered at high plasma levels.

Monitoring of tricyclic antidepressant plasma levels and clinical response: a review of the literature. Part I.

1989 ◽  
Vol 4 (1) ◽  
pp. 43-60 ◽  
Author(s):  
I.R. De Oliveira ◽  
P.A.S. Do Prado-Lima ◽  
B. Samuel-Lajeunesse
Keyword(s):  
Plasma Concentration ◽  
Plasma Level ◽  
Clinical Response ◽  
Plasma Levels ◽  
Tricyclic Antidepressants ◽  
Tricyclic Antidepressant ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Plasma Level Monitoring ◽  
Level Monitoring

SummaryPart I of this paper presents a comprehensive review of plasma level monitoring of tricyclic antidepressants (TCAs) and their relationship to clinical response to antidepressant therapy. Imipramine, nortriptyline, amitriptyline, clomipramine and desipramine are the most widely studied TCAs in this regard. Typical therapeutic plasma concentration ranges are suggested for some of these agents, although a consensus is lacking.

Lithium Intoxication Mimicking Clinical and Electrographic Features of Status Epilepticus: A Case Report and Review of the Literature

2003 ◽  
Vol 34 (1) ◽  
pp. 28-31 ◽  
Author(s):  
M. Gansaeuer ◽  
T. M. Alsaadi
Keyword(s):  
Case Report ◽  
Status Epilepticus ◽  
Plasma Level ◽  
Mental Status ◽  
Plasma Levels ◽  
Mental Function ◽  
Review Of The Literature ◽  
Lithium Intoxication ◽  
Eeg Abnormalities ◽  
Previously Treated

A 58-year-old patient who was somnolent, distractible and confused is presented. She was previously treated with lithium, and a plasma level was mildly elevated at 1.7 mmol/l (normal 0.5–1.5 mmol/l). The EEG was suggestive of electrographic status epilepticus. Following treatment with i.v. lorazepam, neither mental status nor EEG abnormalities improved. She had a full recovery of mental function and markedly improved EEG findings following discontinuation of lithium. The EEG is an effective tool for diagnosing lithium neurotoxicity in patients with normal or mildly elevated lithium plasma levels. However, caution is needed before making an assumption of status epilepticus.

Nortriptyline Plasma Levels and Subjective Side Effects*

1978 ◽  
Vol 132 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Vincent E. Ziegler ◽  
John R. Taylor ◽  
Richard D. Wetzel ◽  
John T. Biggs
Keyword(s):  
Side Effects ◽  
Plasma Level ◽  
Plasma Levels ◽  
Tricyclic Antidepressants ◽  
Dry Mouth ◽  
Severity Of Depression ◽  
The Common ◽  
Pre Treatment ◽  
The Individual ◽  
Subjective Side

Nortriptyline plasma levels and the incidence and severity of the common subjective side effects of the tricyclic antidepressants were determined in 26 patients during six weeks of treatment with nortriptyline. The total corrected (treatment minus pre-treatment) score of the eight side effects most independent of the severity of depression correlated (0 · 60) with the nortriptyline plasma level. Increased perspiration (o · 59) and dry mouth (o · 54) were the individual corrected side effects which most consistently correlated with the plasma level. These subjective side effects may serve as clinically useful guides to dosage adjustments during treatment, though their value is limited by the magnitude of the correlations and the need to correct for their presence prior to treatment.

scholarly journals Influence of the prehospital administered dosage of epinephrine on the plasma levels of catecholamines in patients with out-of-hospital cardiac arrest

Heliyon ◽  
2021 ◽  
pp. e07708
Author(s):  
Jun Nakajima ◽  
Yusuke Sawada ◽  
Yuta Isshiki ◽  
Yumi Ichikawa ◽  
Kazunori Fukushima ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Plasma Levels ◽  
Hospital Cardiac Arrest

Overdose of Dologesic with a Fatal Outcome: A Case Report

2001 ◽  
Vol 8 (4) ◽  
pp. 207-211 ◽  
Author(s):  
CY Man
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Case Report ◽  
Drug Overdose ◽  
Fatal Outcome ◽  
Common Cause ◽  
Accident And Emergency ◽  
Accident And Emergency Department

Dologesic is a commonly prescribed analgesic in accident and emergency department. Yet report of overdose with this drug is not common. We report a case in which the patient developed cardiac arrest within an hour of ingestion. Dextropropoxyphene, a component of the drug Dologesic, used to be a common cause of fatalities after drug overdose in the seventies. It is highly toxic in overdose and therefore caution should be exercised when prescribing this drug.

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