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Toxicological Controversies Series

The Use of Hypertonic Saline in Cyclic Antidepressant Overdose

August 2016| Sophie Gosselin


Cyclic antidepressant overdose is a common presentation in clinical practice. The AAPCC reported that Tricyclic Antidepressants account for about 2.27 % of total deaths1.  As this toxicity manifests as rapidly altered mental status and early hemodynamic instability mainly from sodium channel blockade. Sodium bicarbonate is recommended as first line therapy in many publications 2. However, another potential treatment, hypertonic saline has been reported in case reports and experimental studies as an effective modality for the treatment of this overdose.


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1-JAMES B. MOWRY, DANIEL A. SPYKER, LOUIS R. CANTILENA JR, NAYA MCMILLAN, MARSHA FORD  2013Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report, Clinical Toxicology (2014), 52, 1032–1283 Copyright © 2014 Informa Healthcare USA, Inc. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.3109/15563650.2014.987397


2-Liebelt, Erica L. "Cyclic Antidepressants." Goldfrank's Toxicologic Emergencies, 10e. Eds. Robert S. Hoffman, et al. New York, NY: McGraw-Hill, 2015. n. pag. AccessEmergency Medicine 20-24.


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