Survival after multiple in-hospital cardiac
arrests due to severe amitriptyline poisoning–
a case report

Survival after multiple in-hospital cardiac
arrests due to severe amitriptyline poisoning–
a case report

Severe amitriptyline toxicity, Multiple cardiac arrest, ACLS, Refractory arrhythmias, Sodium bicarbonate

Abstract
Background Amitriptyline, a classic tricyclic antidepressant, can produce toxic effects ranging from mild
antimuscarinic symptoms to severe cardiotoxicity due to sodium channel blockade. In severe cases, toxicity may
rapidly progress to cardiac arrest if not promptly recognized and managed.
Case presentation We present a 25-year-old man who attempted suicide by ingesting 3.25 g of amitriptyline. He
developed two episodes of cardiac arrest and recurrent life-threatening arrhythmias but was resuscitated and later
discharged without neurological deficits. Management included aggressive supportive care, administration of sodium
bicarbonate as the main antidotal therapy, and prolonged resuscitative efforts in the intensive care unit.
Conclusion This case highlights that survival with good neurological outcome is possible even after multiple
toxin-induced cardiac arrests when timely and persistent resuscitative measures are undertaken. It emphasizes
the importance of early recognition of tricyclic antidepressant toxicity, prompt initiation of specific therapy, and
preparedness for cardiac complications—particularly in low-resource settings. In addition, this report draws attention
to the public health concern related to the accessibility and misuse of tricyclic antidepressants.
Keywords Severe amitriptyline toxicity, Multiple cardiac arrest, ACLS, Refractory arrhythmias, Sodium bicarbonate

Amanuel Dagabas Wakoya1* , Tadesse G. Asenabeto1

, Hawi D. Moti1

, Negash B. Bayu1

, Fenta Wondimneh2
,

Abebe D. Ayinalem1

, Alemu B. Mesekere1

, Ayto A. Negash3

and Tiliksew A. Tesfaw1

https://doi.org/10.1186/s12245-025-01109-6

2026

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