Post Your Cases > Lipid rescue in fluxetine/Amiptriptyline/Paracetamol/codeine overdose

A 49 year old lady with a history of depression and previous episodes of self harm attended A&E after an overdose of (presumed) 3.3g amitriptylline, 14g paracetamol, 1.5g codeine, and 660mg fluoxetine. GCS initially 15, then dropped to 9. Cardiovascularly unstable with a BP of 66/40, sinus tachy of 110-120 and sagging ST segments.

Initial resuscitation was with 1L colloid, 2L crystalloid. A naloxone infusion was started with a transient improvement in GCS to 10. Boluses of metaraminol were given with minimal initial response. 50mmol of Sodium bicarbonate was given, followed by a 100ml bolus of intralipid. 900ml further intralipid was given over the next hour. Haemodynamic stability rapidly improved, as did ST segment depression- allowing a comfortable and easy rapid sequence induction with subsequent ICU transfer.

She was also treated with N-Acetyl Cysteine. She was extubated uneventfully 9 hours after her initial assessment by critical care.

The gift of the glob seemed to help....
November 8, 2011 | Unregistered CommenterSegun Olusanya
Very interesting case of mixed drug overdose. Glad to hear the patient did well. Thanks for the post.
Guy
November 13, 2011 | Registered Commenter[Guy Weinberg]