Case report: successful lipid resuscitation in multi-

drug overdose with predominant tricyclic antidepressant toxidrome Martyn Harvey1 * and Grant Cave2 We report a case of profound neurologic and cardiovascular manifestations of tricyclic antidepressant intoxication following self-poisoning with multiple pharmaceuticals including amitriptyline in excess of 43 mg/kg, in a 51-year-old male. Institution of mechanical ventilation, volume expansion, systemic alkalinisation (pH 7.51), and intermittent bolus metaraminol resulted in QRS narrowing but failed to resolve the developed shock. One 100-ml bolus of 20% lipid emulsion followed by a further 400 ml over 30 min was administered with restoration of haemodynamic stability, thereby curtailing the need for ongoing vasopressor medications. Assayed blood levels were consistent with the ‘lipid sink ’ being a major effecter in the observed improvement. Background Therapeutic use of intravenous lipid emulsion (ILE) in the arrested patient secondary to lipophilic cardiotoxin overdose is increasingly reported, with numerou