Tricyclic antidepressant and serotonergic toxicity practice

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Any stageFoundations71Mechanisms of disease35Clinical rotations832Pre-internship488

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Emergency and Toxicologycommon

A 28-year-old woman is brought in by ambulance 90 minutes after being found drowsy next to an empty box of amitriptyline. Her Glasgow Coma Scale score is 12, heart rate 126/min, blood pressure 96/60 mmHg; her pupils are 6 mm and sluggish, her skin is dry and flushed, and bowel sounds are absent. The ECG shows sinus tachycardia with a QRS duration of 132 ms (normal <120) and a prominent terminal positive deflection in lead aVR. Which one of the following intravenous therapies is the most appropriate next step in management?