Regarding 'Therapeutic plasma exchange in amitriptyline intoxication: Case report and review of the literature'

摘要

I have read with great interest the interesting case report (Therapeutic plasma exchange in amitriptyline intoxication) presented by Sari et al. published in your journal [1]. They managed a comatose case (Glasgow Coma Score = 4) of amitriptyline intoxication who presented with sinus tachycardia and weak respiratory efforts. She was seizure-free and did not have hypotension, QRS widening, and/or dysrhythmias. After being intubated and performance of gastric lavage, charcoal and sodium bicarbonate infusion were administered. It seems that plasma exchange has been initiated for the patient with respiratory depression and coma as the criteria for the decision to perform exchange. After the first session of plasma exchange, her GCS increased to 14. Interestingly, the second session has been performed for the patient while she has had a GCS of 14.1 have two major questions regarding the management of this patient; firstly, what was the indication for the initiation of sodium bicarbonate therapy in this patient? As you know, alkalin-ization and sodium loading with sodium bicarbonate along with controlled ventilation should be administered to all cyclic antidepressant overdosed patients presenting with major cardiovascular toxicity and altered mental status [2]. This is while their patient has had no major cardiovascular toxicity. She only had a sinus tachycardia.