Fri12November0729PM 2

A 27-year-old female presents to you unconscious, with a Glasgow coma scale score of E2 V2 M4 and dilated pupils. The only history you have is that she has taken an overdose and vomited.

The paramedics have commenced intravenous fluids, but despite this her blood pressure is 90/40 mmHg and heart rate is 120/min. A bedside blood sugar is 4 mmol/L. She is catheterised and is passing urine.

The nurse switches on the cardiac monitor and the trace is as follows:

Which of the following drugs is she most likely to have consumed?

(Please select 1 option)

Dosulepin This is the correct answer

Ropinirole

Quetiapine

Risperidone

Fluoxetine Incorrect answer selected

Explanation

Tricyclic antidepressant (TCA) drugs are highly toxic when taken in overdose causing neurological and cardiac adverse effects in particular.

Common adverse effects of tricyclic overdose include:

anticholinergic side effects

sedation

agitation

hallucinations

convulsions

ventricular arrhythmias, and

hypotension.

Management may include tracheal intubation due to reduced level of consciousness and activated charcoal if the patient presents within two hours of consumption.

This class of antidepressant has largely been replaced with selective serotonin re-uptake inhibitors (SSRIs).

Answer Statistics

1

40%

2

5%

3

19%

4

10%

5

28%

Times answered: 265