His daughter discovers a puzzled 60-year-old man at home. He is taken to the emergency room by ambulance after emergency medical services are contacted. The patient's daughter, who is with him, claims to have discovered an empty amitriptyline bottle next to his bed. He hasn't been using any more prescription drugs. The patient is delusional at the emergency room and claims to see little animals roaming about in the room's corner. He seemed to be flushed. After a short episode, the patient loses consciousness. Blood pressure is 90/62 mm Hg, the temperature is 37.2 C (99 F), and the pulse rate is 120. His skin and mucous membranes are dry, and his pupils are dilated and equally sensitive to light. Initial ECG shows QRS widening and QTc prolongation. He is transferred to the intensive care unit but dies despite resuscitation attempts. Which of the following pharmacological effects most likely contributed to the patient's death?

Question

His daughter discovers a puzzled 60-year-old man at home. He is taken to the emergency room by ambulance after emergency medical services are contacted. The patient's daughter, who is with him, claims to have discovered an empty amitriptyline bottle next to his bed. He hasn't been using any more prescription drugs. The patient is delusional at the emergency room and claims to see little animals roaming about in the room's corner. He seemed to be flushed. After a short episode, the patient loses consciousness. Blood pressure is 90/62 mm Hg, the temperature is 37.2 C (99 F), and the pulse rate is 120. His skin and mucous membranes are dry, and his pupils are dilated and equally sensitive to light. Initial ECG shows QRS widening and QTc prolongation.  He is transferred to the intensive care unit but dies despite resuscitation attempts.   Which of the following pharmacological effects most likely contributed to the patient's death?

Quizplus · Accepted Answer

Eductional Objective: Due to the blockage of fast sodium channels in cardiac myocytes, a tricyclic antidepressant overdose can result in deadly ventricular arrhythmias and refractory hypotension. Treatment for related cardiac toxicity with sodium bicarbonate involves raising serum pH and extracellular sodium levels (alleviating fast sodium channel blockade).

His Daughter Discovers a Puzzled 60-Year-Old Man at Home