A 44 year old woman was admitted to our intensive care unit five hours after ingestion of amitriptyline. She was comatose (Glasgow coma score 3) with dilated pupils non-reactive to light and accommodation. Biochemical findings and serum electrolytes were normal. Arterial blood gas measurements revealed a slight metabolic acidosis. She was immediately intubated and mechanically ventilated. Gastric lavage was performed for gastrointestinal decontamination followed by the administration of activated charcoal. She recovered after 10 days in the intensive care unit with no apparent neurological sequelae.

The admission ECG showed sinus tachycardia (125 beats/min) with a few supraventricular premature beats, QRS interval widening of 150 ms resembling right bundle branch …