Transcript TCA Case
Dosing By Body Weight? Ms KB 29 yr female Generalised seizure 1st episode Presented to local GP run hospital History Tonic clonic seizure witnessed by partner Self terminated after < 10 minutes Ambulance transfer to local hospital On arrival agitated, settled following IV diazepam Past history Fibromyalgia Sjogren’s Syndrome Meningococcal meningitis 1994 Depression Morbid Obesity Medications Amitriptyline 50 mg QID Panadeine Forte q 6 h No Known Drug Allergies Background History 3/52 dizzy spells, falls, difficulty in sentence formation 1/52 poor balance, intermittent blurred vision In bed for previous 48 hours Fell as attempting to walk to lounge, hit head, generalised seizure, non responsive for 10 minutes Initial Examination BP 135/85 mmHg, Pulse 85, 100% sat on RA GCS 12, irrational and aggressive but no focal neurological signs CVS, Resp, Abdo unremarkable Investigations ECG sinus tachy 95 bpm, QRS 140 ms Treatment Diazepam 10 mg IV Oxygen Transferred by road to DGH At DGH Alert and cooperative BP 138/77 mmHg, pulse 101 Examination unremarkable ECG @ 12.40 shows QRS of 120 ms Commenced on cardiac monitoring Head CT arranged Subsequent events Cardiac Arrest 1345 h in toilet Found in asystole Cardiac output restored @1405 Given NaHCO3 Retrieval to Newcastle Mater ICU Mater ICU Pulse 80 BP 140/80 mmHg Aspiration R LL GCS 5 Asystolic arrest due to amitriptyline, probable hypoxic brain injury Mater ICU Medications as taken – Amitriptyline 200 mg QID – Panadeine Forte 4 tabs q 6 h – For 5 months duration Asystolic arrest due to amitriptyline, probable hypoxic brain injury Subsequent History 3 days later remains intubated, eye open to voice, purposeless limb movements, does not obey commands Extubated on day 13, sent to ward, feeding by NGT Referral to rehab Day 27, following one stage commands, commenced oral feeding Outcome Day 32 discharged to rehab Hypoxic brain injury Discharged home to care of husband Chronic TCA poisoning