Clinical, Paraclinical, and Prognostic Findings of Iranian Patients Poisoned With Tricyclic Antidepressants: A Cross-sectional Study

Background: Tricyclic antidepressant (TCA) poisoning is a serious medical emergency due to its high toxicity and life-threatening complications.Objectives: This retrospective cross-sectional study evaluated the frequency of clinical, paraclinical, and prognostic findings of poisoned patients with TCAs who were referred to Shah Vali Hospital, Yazd, Iran, and Shahid Beheshti Hospital, Taft, Yazd, Iran, between 2014 and 2023.Methods: We collected neurological findings, cardiovascular findings, paraclinical findings, treatment measures, and prognosis of poisoned patients with TCA who were referred to Shah Vali Hospital in Yazd and Shahid Beheshti Hospital in Taft from 2014 to 2023.We examined the patient's medical records to extract the findings.Results: Over a decade-long study, 233 cases of poisoning resulting from TCAs were documented, with a mean age of 28.11 years.Most of these cases involved nortriptyline (42.5%) and amitriptyline (32.6%).Notably, 69.1% of the affected individuals were female.Neurological manifestations included agitation (42.9%), mydriasis (39.05%), and dryness of the skin and mucous membranes (52.3%).Additionally, seizures were reported in 10.7% of patients.Cardiovascular symptoms included shock in 6.2% of cases, tachycardia in 24.56%, and QRS complex prolongation in 14.16%.Elevated lead augmented vector right (aVR) was noted in 7.18% of patients, while rhabdomyolysis occurred in 7%.The primary treatment administered was sodium bicarbonate, utilized in 51.1% of cases.Furthermore, 8.2% of patients had a history of suicide attempts, predominantly associated with amitriptyline use.Ultimately, the mortality rate among this cohort was recorded at 1.7%.The findings suggested