Tricyclic Antidepressant (TCA) Overdose Causing Diffuse Alveolar Hemorrhage: A Case Report

Tricyclic antidepressant (TCA) overdose is an uncommon complication that results from excessive administration of TCAs. Signs and symptoms include bradycardia, fever, dry mouth, and altered mental status. Patients can develop cardiac arrhythmia and diffuse alveolar hemorrhage, which can be fatal. This case report details a 65-year-old female who experienced a suspected TCA overdose as a suicide attempt. She had a history of depression and a previous suicide attempt. The patient was unresponsive with declining oxygen saturation, necessitating emergent intubation. Important lab findings included a decreased partial pressure of oxygen to fraction of inspired oxygen ratio (P/F ratio) and prolonged QRS duration on ECG. She was admitted to the ICU, where her condition worsened, leading to wide complex tachycardia, cardiac arrest, and diffuse alveolar hemorrhage confirmed by bronchoscopy. This case highlights the potential adverse effects of TCA use and raises awareness of an unusual presentation of TCA overdose.