Phenytoin intoxication can occur either with repeated supra therapeutic dosing or an acute overdose. Dose-dependent CNS depression occurs. Most presentations are benign and have good outcomes with supportive care. The main risk to patients is falling which can last days.
Tricyclic Antidepressants (TCA) are weak bases (pKa 8.5) that can cause life-threatening sodium channel toxicity
Middle-aged patient presenting with drowsiness. Brief seizure in ED. BP unrecordable. Interpret the ECG.
Middle-aged patient presenting with drowsiness. BP 85/50. Pupils dilated. Interpret the ECG. TCA overdose, pseudo Brugada
A review of the ECG features seen in TCA overdose, which occur due to a combination of sodium channel blockade and antimuscarinic effects