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Cognitive disorders lead to an increased risk of misuse of medication, resulting in possible auto-intoxication. We describe the case of a 68-year-old patient, with hypothermia and a coma, with accidental tricyclic antidepressant (TCA) intoxication. What is remarkable about this case is that there were no cardiac or hemodynamic abnormalities, which is to be expected with both hypothermia and TCA-intoxication. Intoxication should be considered in patients with hypothermia and a decreased level of consciousness, in addition to primarily neurological or metabolic causes. A good (hetero)anamnesis with attention to pre-existent cognitive functioning is important. Early screening for intoxication in patients with cognitive disorders with a coma and hypothermia is advisable, even in the absence of a typical toxidrome.


Linda J de Vries, Jeroen Boekema, Rahmat Sediq, Amarins Bontemps-Visser, Maureen I de Haan-Lauteslager. Antidepressant overdose resulting in coma and hypothermia]. Nederlands tijdschrift voor geneeskunde. 2022 Feb 22;166

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PMID: 35499563

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