Intravenous Fat Emulsion (IFE) Improvement of Qt-Interval in Tricyclic Antidepressant Overdose

Abstract

Here we report a case of a 62-year-old female with a potentially lethal ingestion of a tricyclic antidepressant (nortriptyline) refractory to conventional therapy. In the emergency department, she was profoundly hypotensive and significantly acidotic. She received several sodium bicarbonate boluses followed by continuous sodium bicarbonate infusion in addition to multiple vasopressors. Despite these measures, the patient remained dangerously hypotensive with a prolonged QT interval. Lipid emulsion was started with a bolus and infusion. Subsequently, the patient successfully weaned off pressor support and her QT interval normalized. After a short hospital course, patient was discharged with only moderate cognitive impairment.