Impact of unusual gastrointestinal problems on the treatment of tricyclic antidepressant overdose.

We report the cases of two patients with tricyclic antidepressant overdose in which the use of charcoal was hampered by gastrointestinal abnormalities. In the first patient, a previous gastric bypass procedure impeded the placement of an orogastric tube and subsequent charcoal administration, while potentially facilitating rapid absorption of the drug--factors that may have contributed to her death. In the second patient, severe esophageal spasm delayed therapy until IV nitroglycerin relieved the functional obstruction. Both circumstances are previously unreported complications associated with tricyclic antidepressant overdose. Potentially corrective measures are proposed.