Survival after multiple in-hospital cardiac arrests due to severe amitriptyline poisoning - a case report

Sep 30, 2026

Uploaded by Jake

Amitriptyline, a tricyclic antidepressant, can progress from mild antimuscarinic symptoms to severe cardiotoxicity via sodium channel blockade, rapidly leading to cardiac arrest without prompt recognition and treatment. The report describes a 25-year-old man who attempted suicide with 3.25 g of amitriptyline and suffered two cardiac arrest episodes with recurrent life-threatening arrhythmias. Aggressive supportive care, sodium bicarbonate as the main antidote, and prolonged ICU resuscitation enabled survival with good neurological outcome. The case emphasizes early TCA toxicity recognition and readiness for cardiac complications, particularly in low-resource settings, and highlights public health concerns about accessibility and misuse.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Introduction

Case presentation

Wakoya et al. International Journal of Emergency Medicine (2026) 19:4 [https://doi.org/10.1186/s12245-025-01109-6](https://doi.org/10.1186/s12245-025-01109-6) International Journal of Emergency Medicine RESEARCH Open Access Survival after multiple in-hospital cardiac arrests due to severe amitriptyline poisoning– a case report Amanuel Dagabas Wakoya 1*, Tadesse G. Asenabeto 1, Hawi D. Moti 1, Negash B. Bayu 1, Fenta Wondimneh2, Abebe D. Ayinalem 1, Alemu B. Mesekere 1, Ayto A. Negash3 and Til iksew A. Tesfaw 1 Abstract Background Amitriptyline, a classic tricyclic antidepressant, can produce toxic effects ranging from mild antimuscarinic symptoms to severe cardiotoxicity due to sodium channel blockade. In severe cases, toxicity may rapidly progress to cardiac arrest if not promptly recognized and managed. Case presentation We present a 25-year-old man who attempted suicide by ingesting 3.25 g of amitriptyline. He developed two episodes of cardiac arrest and recurrent life-threatening arrhythmias but was resuscitated and later discharged without neurological deficits. Management included aggressive supportive care, administration of sodium bicarbonate as the main antidotal therapy, and prolonged resuscitative efforts in the intensive care unit. Conclusion This case highlights that survival with good neurological outcome is possible even after multiple toxin-induced cardiac arrests when timely and persistent resuscitative measures are undertaken. It emphasizes the importance of early recognition of tricyclic antidepressant toxicity, prompt initiation of specific therapy, and preparedness for cardiac complications—particularly in low-resource settings. In addition, this report draws attention to the public health concern related to the accessibility and misuse of tricyclic antidepressants. Keywords Severe amitriptyline toxicity, Multiple cardiac arrest, ACLS, Refractory arrhythmias, Sodium bicarbonate *Correspondence: Amanuel Dagabas Wakoya [amanidag1246@gmail.com](amanidag1246@gmail.com) 1Department of Emergency and Critical Care Medicine, Haramaya university, Harar, Ethiopia 2School of Nursing, Haramaya university, Harar, Ethiopia 3Department of Emergency Medicine and Critical Care, Worabe Comprehensive Specialized Hospital, Werabe University, Central Ethiopia, Ethiopia Introduction Amitriptyline is a tricyclic antidepressant (TCA) belonging to the class of tertiary amine compounds. Introduced in the 1950s, tricyclic antidepressants were among the first generation of drugs developed for the treatment of depression. However, their use has markedly declined over the years with the advent of safer and more selective antidepressants. Despite this, TCAs remain clinically relevant, both for depression and certain chronic pain syndromes. Tricyclic antidepressants are associated with a high risk of toxicity, exhibiting the highest ratio of deaths to exposures among antidepressant overdoses reported to U.S. Poison Control Centers [1]. In 2021, more than one million people in the United States were © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. Wakoya et al

FAQs

What complication can occur after severe amitriptyline toxicity if it is not promptly managed?

Severe cardiotoxicity can progress rapidly to cardiac arrest, along with life-threatening arrhythmias.

How much amitriptyline did the patient ingest in the reported case?

He attempted suicide by ingesting 3.25 g of amitriptyline.

What treatments were emphasized for resuscitation and antidotal management?

Management included aggressive supportive care, airway and circulatory support, sodium bicarbonate as the main antidotal therapy, and prolonged intensive care resuscitation.

Sep 30, 2026

Uploaded by Jake