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Dosing By Body Weight?
Ms KB
29 yr female
 Generalised seizure 1st episode
 Presented to local GP run hospital

History
Tonic clonic seizure witnessed by
partner
 Self terminated after < 10 minutes
 Ambulance transfer to local hospital
 On arrival agitated, settled following IV
diazepam

Past history
Fibromyalgia
 Sjogren’s Syndrome
 Meningococcal meningitis 1994
 Depression
 Morbid Obesity

Medications
Amitriptyline 50 mg QID
 Panadeine Forte q 6 h


No Known Drug Allergies
Background History
3/52 dizzy spells, falls, difficulty in
sentence formation
 1/52 poor balance, intermittent blurred
vision
 In bed for previous 48 hours
 Fell as attempting to walk to lounge, hit
head, generalised seizure, non
responsive for 10 minutes

Initial Examination
BP 135/85 mmHg, Pulse 85, 100% sat
on RA
 GCS 12, irrational and aggressive but no
focal neurological signs
 CVS, Resp, Abdo unremarkable

Investigations

ECG sinus tachy 95 bpm, QRS 140 ms
Treatment
Diazepam 10 mg IV
 Oxygen
 Transferred by road to DGH

At DGH
Alert and cooperative
 BP 138/77 mmHg, pulse 101
 Examination unremarkable
 ECG @ 12.40 shows QRS of 120 ms
 Commenced on cardiac monitoring
 Head CT arranged

Subsequent events
Cardiac Arrest 1345 h in toilet
 Found in asystole
 Cardiac output restored @1405
 Given NaHCO3
 Retrieval to Newcastle Mater ICU

Mater ICU
Pulse 80 BP 140/80 mmHg
 Aspiration R LL
 GCS 5


Asystolic arrest due to amitriptyline,
probable hypoxic brain injury
Mater ICU

Medications as taken
– Amitriptyline 200 mg QID
– Panadeine Forte 4 tabs q 6 h
– For 5 months duration

Asystolic arrest due to amitriptyline,
probable hypoxic brain injury
Subsequent History
3 days later remains intubated, eye
open to voice, purposeless limb
movements, does not obey commands
 Extubated on day 13, sent to ward,
feeding by NGT
 Referral to rehab
 Day 27, following one stage commands,
commenced oral feeding

Outcome
Day 32 discharged to rehab
 Hypoxic brain injury


Discharged home to care of husband
Chronic TCA poisoning