Case history
Case history
A 25-year-old woman with a history of depression is brought to the hospital with altered mental status and a brief seizure. She is obtunded and tachycardic to 127 bpm and her blood pressure is 96/62 mmHg. She appears flushed and is arousable only to vigorous stimulation. Her skin is warm and dry. Pupils are 5 to 6 mm and poorly reactive to light. ECG showed sinus tachycardia with widening of the QRS.
Other presentations
Some chronically poisoned patients retain their mental status, exhibit stable vital signs, and complain only of fatigue. These patients may also exhibit a history of falls or hip fractures. These symptoms arise from the development of orthostatic hypotension as a result of alpha-1 antagonism caused by tricyclic antidepressants, leaving older patients most susceptible.[4]
After an acute overdose, vital signs and ECG findings may resolve leaving the patient with only a residual anticholinergic delirium. This is typically manifested by garbled speech and disorientation with visual and/or tactile hallucinations.
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