An analysis of plasma levels and 24-hour ECG recordings in tricyclic antidepressant poisoning: implications for management.

Twenty-seven patients with confirmed tricyclic antidepressant (TCA) self-poisoning were studied for 24 h following admission to hospital. Ten patients were judged to be severely poisoned on clinical grounds, whilst 14 patients had initial plasma levels above 1 mg l-1, indicating severe poisoning. Plasma levels were generally maximal on admission to hospital and fell quickly thereafter. Clinical and ECG data showed patients to be most at risk in the casualty department and three patients sustained cardiac arrest. Initial management must be speedy as these patients present with acute toxicity.