Abstract
We report a case of acute respiratory distress syndrome (ARDS) associated with tricyclic antidepressant (TCA) overdose. A 34-year-old woman taking clomipramine hydrochloride for depression was admitted to the emergency department of our hospital after ingesting 3.5 g (70 mg/kg) of clomipramine hydrochloride 4 hr prior to arrival. On arrival, her vital signs were normal, and the Glasgow coma scale (GCS) score was E1V1M2. She was admitted to the department of internal medicine. Eleven hours after dose, the GCS score was E3V5M6. Her SpO2 was measured to be 94% when oxygen was supplied through a face mask at 6 l/min. A chest radiograph revealed a bilateral infiltration shadow. Twenty hours after dose, she entered a state of shock. She was transferred to the intensive care unit. We presumed that the cause of ARDS was pneumonia. Although the inflammatory response was improved on antibiotics administration, but the respiratory condition did not. After the administration of the methylpredonizorone on the 12th day, the respiratory condition gradually improved. On the 14th day, she was weaned from mechanical ventilation, and on the 22nd day, she was discharged. Cases of ARDS associated with TCA overdose have been reported from abroad. The lung injury caused by TCA overdose has also been reported in experimented conducted on animals. Physicians should include the possibility of developing ARDS when encountering a patient of TCA overdose.
