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TCA overdose — RACP Paediatrics MCQ

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ModerateEmergencyTCA overdoseRACP Paediatrics

A 3-year-old is found with an empty bottle of grandmother's amitriptyline. He presents with altered consciousness, seizures, tachycardia with a wide QRS complex on ECG, and dilated pupils. What is the most likely ingestion?

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Correct answer: A — Tricyclic antidepressant overdose

The triad of altered consciousness, seizures, and cardiac toxicity (wide QRS complex tachycardia) with anticholinergic features (dilated pupils, tachycardia, urinary retention, dry skin) is characteristic of tricyclic antidepressant (TCA) overdose. IV sodium bicarbonate is the specific treatment for TCA cardiotoxicity (targeting QRS narrowing). Cardiac monitoring for at least 12 hours is essential.

Reference: RCH Melbourne – 2023 – Poisoning CPG; Australian Therapeutic Guidelines – 2024 – Toxicology