In this section
Poisoning - Acute guidelines for initial managementUse of activated charcoal in poisoningsSerotonin syndromeAnticholinergic Syndrome Febrile Seizures
For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26
(TCA) are one of the common causes of a fatal drug overdose. They have a narrow
therapeutic window so can be fatal at relatively lower doses and single tablet
fatalities have been reported. Its most serious effects are cardiovascular and CNS
instability. Patients have the potential to deteriorate quickly. Most poisoning
presentations are from an acute ingestion; however chronic poisoning can also present
have their toxic effects through action at 4 main receptors involving
If TCA poisoning is suspected, please seek
senior advice and discuss with a toxicologist.
Symptoms based on toxidrome:
antidote, treatment is supportive
Standard procedures and supportive care.
Consider intubation early in reduced GCS.
Charcoal is generally contraindicated
due to risk of aspiration however patients with ingestion of doses >10-15 mg/kg
should be given charcoal following intubation
If QRS widened or Ventricular arrhythmia, commence alkalization with Sodium Bicarbonate bolus 2 mmol/kg. Repeat boluses may be given in addition to consideration
to intubation and hyperventilation to optimise pH to 7.5.
Admission should be
Patients with an
intentional overdose should have a mental health review.
Contact Victorian Poisons Information Centre
13 11 26 for advice
Patient with significant
CNS depression/seizures or any cardiovascular instability.Patient requiring
care beyond the comfort level of the current hospital
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
Normal GCSNormal ECGPeriod of observation for 6 hours if stableFor deliberate ingestion, a risk assessment should indicate that
the patient is at low risk of further self-harm in the discharge setting
Accidental ingestion: Parent information sheet from Victorian Poisons Information centre
on the prevention of poisoning
self-harm: Referral to local mental health services e.g. Orygen Youth
Health: 1800 888 320
Recreational poisoning: Referral
Victoria's Youth Drug and Alcohol Advice service: 1800 458
Last updated June 2017