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TCA poisoning (Clinical presentation (Dry mouth, Dilated pupils,…
TCA poisoning
Clinical
presentation
Dry mouth
Dilated pupils
Palpitations
Oligouria/anuria
Ataxia
Reduced conciousness/coma
Seizures
Diagnosis
Examination
General: dry skin/mucous membranes
Cardio - tachycardia, may have low BP
Resp: may be nil
Abdo: oligouria/anuria
Neuro: dilated pupils, reduced GCS, ataxia,
hypertonia, hyperreflexia, extensor plantar,
myclonus, seizures
Investigations
Bloods
ABG
(metabolic acidosis)
FBC, U+E, LFTs
Toxicology
Bedside
Obs: tachycardia, may have low BP
ECG: sinus tachy, prolonged PR, wide QRS,
ventricular arrhythmias, bradycardia
History
PC/HPC: symptoms, dose, timing
PMH: psychiatric disorder, prev ODs
DH: TCAs, allergies
SH: illicit drugs, alcohol, smoking
Pathophysiology
TCAs are anti-muscarinic agents so
get exagerrated anti-muscarinic effects
Similar presentation with other antimuscarinics
e.g. atropine, deadly nightshade
Management
Definitive
Medical
Activated charcoal
Indication: ingestion <1h
MOA: reduces absorption
Na bicarb
Indication: cardiac arrhythmia/shock
MOA: improves rhythm and CO
Conservative
Monitoring (ABG, cardiac, obs)
Stop anti-arrhythmic drugs
IV fluids
Initial ABCDE
Definition
Ingestion of an antimuscarinic
agent to sufficently toxic levels