Overdose - Tricyclic Antidepressant

You have been called for a 18 y/o M who is unresponsive. Time is 2030 hrs.

A) What could be going with this patient?

As you walk into the room, you notice the patient laying on his side, with an empty bottle of pills next to him. As you start to assess the patient, you find him unresponsive to all stimuli, normal pupils, no trauma noted, BP 90/P, Pulse 142, Sinus Tach on the monitor, Resp 10/min, Dexi 120, Skin warm/dry.

You notice that the bottle of pills, is Adapin. 30 pills are supposed to be in the bottle, total (just had it filled two days ago). He takes one ever morning. 15 pills are missing from the bottle, and 12 pills are scattered on the floor next to him. Don't forget, he already took 3 pills, due to the bottle being filled two days ago. So, he may have ingested a total of 12 pills. 

1) What is Adapin? 

Medical History: Depression, anxiety, asthma

Medication: Adapin, Albuterol, 

Allergies: PCN

2) What do you want to do, at this point (procedures)?

3) What drug do you want to give to this patient? Dosage? Why? How does it work?

Your patient weights 140 lbs.

4) What is the dose that you want to give to your patient?

You overhear part of the conversation between the police office and the patients moth. The patient's mother stated that when he came home from school, he seemed "different." "He seemed like he was down." In addition, she stated that he went up to room, turned the radio on, and stayed in there until dinner. During dinner, he was very quite, and went up to his room right after eating. When she went to say goodnight, she found him laying their on the floor, with his bottle of Adapin next to him. 

5) Transport priority? 

After you give Sodium Bicarbonate to the patient, he becomes somewhat alert. Vitals are all still stable.

6) What happened to the patient?

7) What are you going to do during transport?

8) What is this patient at risk of developing?

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ANSWERS TO QUESTIONS BELOW

(make sure you try to answer the questions before you read below this line)

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A) What could be going on with this patient?

         -Overdose, hypoglycemia, etc...

1) What is Adapin?

         -Tricyclic Antidepressant 

2) What do you want to do, at this point?

         -Oxygen (NRB), IV Access, Monitor, prepare/consider for intubation

3) What drug do you want to give? Dosage? Why? How does it work?

         -Sodium Bicarbonate

         -1 mEq/kg

         -Adapin is an acid, so by giving Sodium Bicarb (base), we can increase blood pH

         -It works by attaching to hydrogen molecules, causing the molecules to become a base, which in 

              turn will increase blood pH, which makes the blood --> body more base
4) What is the dose that you want to give to your patient?
          -63 mEq of Sodium Bicarbonate
          -Math: 1 mEq/kg is the dose. Your patient weight 63 kg. 1mEq/kg X 63kg = 63 mEq.

5) Transport priority? 

          -Priority 1
6) What happened to this patient?

          -OD on his Adapin

7) What are you going to do during transport?

          -Oxygen, monitor vitals (every 5 minutes), ECG, airway

8) What is this patient at risk of developing?

           -Respiratory arrest, cardiac arrest, death



*For any Tricyclic Antidepressant OD, we give Sodium Bicarbonate, with a dose of 1 mEq/kg.*