Survival after multiple in-hospital cardiac arrests due to severe amitriptyline poisoning– a case report

Abstract

Background: Amitriptyline, a classic tricyclic antidepressant, can produce toxic effects ranging from mild antimuscarinic symptoms to severe cardiotoxicity due to sodium channel blockade. In severe cases, toxicity may rapidly progress to cardiac arrest if not promptly recognized and managed. Case presentation: We present a 25-year-old man who attempted suicide by ingesting 3.25 g of amitriptyline. He developed two episodes of cardiac arrest and recurrent life-threatening arrhythmias but was resuscitated and later discharged without neurological deficits. Management included aggressive supportive care, administration of sodium bicarbonate as the main antidotal therapy, and prolonged resuscitative efforts in the intensive care unit. Conclusion: This case highlights that survival with good neurological outcome is possible even after multiple toxin-induced cardiac arrests when timely and persistent resuscitative measures are undertaken. It emphasizes the importance of early recognition of tricyclic antidepressant toxicity, prompt initiation of specific therapy, and preparedness for cardiac complications—particularly in low-resource settings. In addition, this report draws attention to the public health concern related to the accessibility and misuse of tricyclic antidepressants.