Research Article
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Year 2020, Volume: 2 Issue: 3, 57 - 63, 05.12.2020

Abstract

Giriş
Trisiklik antidepresan (TSA) zehirlenmesi, kardiyovasküler sistem dahil olmak üzere çeşitli sistemleri etkileyebilir. Son yıllarda, Tp-Te aralığı, Tp-Te dispersiyonu ve Tp-Te / QT gibi transmiyokardiyal repolarizasyon parametrelerinin artmış kardiyak aritmi riski ile ilişkili olduğu gösterilmiştir. Bu çalışmanın amacı, TSA intoksikasyonunun transmiyokardiyal repolarizasyon parametreleri üzerindeki etkisini değerlendirmektir.
Yöntemler
Bu çalışma, TSA intoksikasyonu için izlenen ve tedavi edilen 124 hasta (43 erkek ve 81 kadın) ve 37 gönüllü kontrolü içeren kesitsel bir çalışmadır. Başvuru anında, 6. saat ve 24. saatte hastaların elektrokardiyogramları değerlendirilerek Tp-Te ve QT intervali manuel olarak ölçülerek Tp-Te / QT oranı hesaplandı.
Bulgular
Çalışma grubunun yaş ortalaması 27.95 ± 7.72 idi. Hasta ve kontrol grupları arasında V2-6 derivasyonlarında Tp-Te (p <0.001), Tp-Te ortalaması (p <0,05) ve dağılımı (p <0,05) açısından istatistiksel olarak anlamlı fark vardı. V2-5 derivasyonlarında Tp-Te / QT değerlerinde anlamlı farklılık vardı (p <0,05). Hasta ve kontrol grupları arasında maksimum ve minimum QT değerleri, uzamış QTc, uzamış QTc dispersiyonu ve uzamış ortalama Tp-Te / QT değerlerinde istatistiksel olarak anlamlı fark bulundu (p <0,05); uzamış ortalama Tp-Te değerleri gruplar arasında benzerdi (p = 0,117). Tp-Te ve Tp-Te / QT verilerinin hastalığı öngörmedeki tanısal değerini araştırmak için yapılan ROC analizinde V2 derivasyonu dışındaki tüm derivasyonların tanısal olduğunu bulduk (p <0.05).
Sonuç
TSA intoksikasyonu, transmiyokardiyal repolarizasyon parametrelerini sağlıklı popülasyona göre anlamlı olarak artırmaktadır.

References

  • 1. Bronstein AC, Spyker DA, Cantilena JRM, Louis R, Green JL, Rumack BH, et al. 2009 Annual report of the American Association of Poison Control Centers' national poison data system (NPDS): 27th annual report. Clinical Toxicology. 2010;48:979-1178.
  • 2. Small GW. Treatment of geriatric depression. Dep Anx Supp 1998; 1: 32–42.
  • 3. Deegan C, O'Brien K. Amitriptyline poisoning in a 2‐year old. Pediatric Anesthesia. 2006;16(2):174-7.
  • 4. Nelson, JC, Spyker, DA. Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014. American Journal of Psychiatry.2017;174,438–50.
  • 5. Biçer S, Sezer S, Çetindağ F, Kesikminare M, Tombulca N, Aydoğan G, et al. Acil Çocuk Kliniği 2005 Yılı Akut Zehirlenme Olgularının Değerlendirilmesi. Marmara Medical Journal 2007;20;12-20
  • 6. Hawton K, Bergen H, Simkin S, Cooper J, Waters, K, Gunnell D, et al. Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose. British Journal of Psychiatry. 2010; 196: 354–358.
  • 7. McKenzie MS, McFarland BH. Trends in antidepressant overdoses. Pharmacoepidemiol Drug Saf 2007; 16:513-23.
  • 8. Liebelt EL, Francis PD, Woolf AD. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Annals of emergency medicine. 1995;26:195-201.
  • 9. Singh N, Singh HK, Khan IA. Serial electrocardiographic changes as a predictor of cardiovascular toxicity in acute tricyclic antidepressant overdose. American journal of therapeutics. 2002;9:75-9.
  • 10. Woolf AD, Erdman AR, Nelson LS, Caravati EM, Cobaugh DJ, Booze LL, et al. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology. 2007; 45: 203–233.
  • 11. Mills KC. Tricyclic antidepressants. In Tintinalli JE, Kellen G, Stapczynski JS, editors. Emergency Medicine A Comprehensive Study Guide. 6th ed. New York: McGraw-Hill; 2004. pp. 1025-33
  • 12. Hevia JC, Antzelevitch C, Bárzaga FT, Sánchez MD, Balea FD, Molina RZ, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. Journal of the American College of Cardiology. 2006;47(9):1828-34.
  • 13. Linden C, Burns J. Poisoning and drug overdosage. In Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill; 2006. pp. 2581-93.
  • 14. Özköse Z, Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Human & experimental toxicology. 1999;18:614-8.
  • 15. Goksu S, Yildirim C, Kocoglu H, Tutak A, Oner U. Characteristics of acute adult poisoning in Gaziantep, Turkey. Journal of Toxicology: Clinical Toxicology. 2002;40:833-7.
  • 16. Yavuz S. Aydın S. Zehirlenme olgularının profili. Toksikoloji dergisi. 2003;1:47-52.
  • 17. Akköse Ş, Fedakar R, Bulut M, Çebiçci H. Zehirlenme olgularının beş yıllık analizi. Acil Tıp Dergisi. 2003;3:8-10.
  • 18. Harrigan RA, Brady WJ. ECG abnormalities in tricyclic antidepressant ingestion. The American journal of emergency medicine. 1999;17:387-93.
  • 19. Graudins A, Dowsett RP, Liddle C. The toxicity of antidepressant poisoning: is it changing? A comparative study of cyclic and newer serotonin‐specific antidepressants. Emergency Medicine. 2002;14:440-6.
  • 20. Mak KK, Ho CS, Zhang MW, Day JR, Ho RC. Characteristics of overdose and non-overdose suicide attempts in a multi-ethnic Asian society. Asian journal of psychiatry. 2013;6:373-9.
  • 21. Whyte IM, Dawson A, Buckley N. Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants. Qjm. 2003;96:369-74.
  • 22. Foulke GE. Identifying toxicity risk early after antidepressant overdose. The American journal of emergency medicine. 1995;13:123-6.
  • 23. Henry JA, Antao CA. Suicide and fetal antidepressant poisoning. Eur J Med 1992; 458–65.
  • 24. Høegholm A, Clementsen P. Hypertonic sodium chloride in severe antidepressant overdosage. Journal of Toxicology: Clinical Toxicology. 1991;29:297-8.
  • 25. DeBattista C. Antidepressant agents. In Katzung BG, Masters SB, Trevor AJ, editors. Basic & Clinical Pharmacology,12th ed. NY: McGraw Hill; 2012. pp.521-40.
  • 26. Benowitz NL. Tricyclic Antidepressants In Olson KR, editor. Poisoning and Drug Overdose. USA: Appleton and Lange; 1999. pp:310-12. 27. Unverir P, Atilla R, Karcioglu O, Topacoglu H, Demiral Y, Tuncok Y. A retrospective analysis of antidepressant poisonings in the emergency department: 11-year experience. Human & experimental toxicology. 2006;25:605-12.
  • 28. Stern TA, O'gara PT, Mulley AG, Singer DE, Thibault GE. Complications after overdose with tricyclic antidepressants. Critical care medicine. 1985;13:672-4.
  • 29. Groleau G, Jotte R, Barish R. The electrocardiographic manifestations of cyclic antidepressant therapy and overdose: a review. The Journal of emergency medicine. 1990;8:597-605.
  • 30. Phillips S, Brent J, Kulig K, Heiligenstein J, Birkett M, Group AS. Fluoxetine versus tricyclic antidepressants: a prospective multicenter study of antidepressant drug overdoses. The Journal of emergency medicine. 1997;15:439-45.
  • 31. Dökmeci İ.Trisiklik antidepresanlar. In Dökmeci İ, editor. Toksikoloji. 3rd ed. İstanbul: Nobel Tıp Kitapevleri; 2001. pp:414-5.
  • 32. Arranto C, Mueller C, Hunziker P, Marsch S, Eriksson U. Adverse cardiac events in ICU patients with presumptive antidepressant overdose. Swiss Medical Weekly. 2003;133:479–83
  • 33. Bosch TM, van der Werf TS, Uges DR, Ligtenberg JJ, Fijen Jw, Tulleken JE, et al. Antidepressants self-poisoning and ICU admissions in a university hospital in The Netherlands. Pharmacy World and Science. 2000;22:92-5.
  • 34. Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. American heart journal. 2005;150:1115-21.
  • 35. Hennessy S, Bilker WB, Knauss JS, Margolis DJ, Kimmel SE, Reynolds RF, et al. Cardiac arrest and ventricular arrhythmia in patients taking antipsychotic drugs: cohort study using administrative data. BMJ. 2002;325:1070.
  • 36. Acar G, Akkoyun M, Nacar A, Dirnak I, Yıldırım ÇG, Nur YM, et al. Evaluation of Tp-e interval and Tp-e/QT ratio in patients with rheumatoid arthritis. Turk Kardiyoloji Dernegi arsivi. 2014;42:29-34.
  • 37. Yamaguchi M, Shimizu M, Hidekazu I, Terai H, Uchiyama K, Kotaro O, et al. T wave peak-to-end interval and QT dispersion in acquired long QT syndrome: a new index for arrhythmogenicity. Clinical Science. 2003;105:671-6.
  • 38. Shimizu M, Ino H, Okeie K, Yamaguchi M, Nagata M, Hayashi K, et al. T‐peak to T‐end interval may be a better predictor of high‐risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clinical cardiology. 2002;25:335-9.
  • 39. Topilski I, Rogowski O, Rosso R, Justo D, Copperman Y, Glikson M, et al. The morphology of the QT interval predicts torsade de pointes during acquired bradyarrhythmias. Journal of the American College of Cardiology. 2007;49:320-8.
  • 40. Watanabe N, Kobayashi Y, Tanno K, Miyoshi F, Asano T, Kawamura M, et al. Transmural dispersion of repolarization and ventricular tachyarrhythmias. Journal of electrocardiology. 2004;37:191-200.
  • 41. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. Tpe/QT ratio as an index of arrhythmogenesis. Journal of electrocardiology. 2008;41:567-74.

Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication

Year 2020, Volume: 2 Issue: 3, 57 - 63, 05.12.2020

Abstract

Introduction
Tricyclic antidepressant (TCA) intoxication can affect various systems including cardiovascular system. In recent years, the transmiyocardial repolarization parameters including T peak-Tend (Tp-Te) interval, Tp-Te dispersion and Tp-Te/QT have been shown to be associated with increased cardiac arrhythmia risk. The aim of this study was to evaluate the effect of TCA intoxication on transmyocardial repolarization parameters.
Methods
This study was a cross-sectional study including 124 patients (43 male and 81 female) who were followed up and treated for TCA intoxication and 37 volunteer controls. At admission, 6th hour and 24th hour, the electrocardiogram of the patients were evaluated and Tp-Te and QT interval were measured manually and Tp-Te/QT ratio was calculated.
Results
The mean age of the study group was 27.95±7.72. There were statistically significant difference in terms of Tp-e (p<0.001), Tp-Te mean (p<0,05) and dispersion (p <0,05) in V2-6 derivations between patient and control groups. There were significant difference in the Tp-Te/QT values in V2-5 derivations (p<0,05). We found a statistically significant difference in maximum and minimum QT values (p<0,001), prolonged QTc, prolonged QTc dispersion and prolonged mean Tp-Te/QT values between patient and control groups (p <0.05); prolonged mean Tp-Te values were similar between groups (p = 0,117). In the ROC analysis performed to investigate the diagnostic value of Tp-Te and Tp-Te/QT data in predicting disease, we found that all leads except V2 derivation were diagnostic (p <0.05).
Conclusion
TCA intoxication significantly increased the transmiyocardial repolarization parameters compared to the healthy population.

References

  • 1. Bronstein AC, Spyker DA, Cantilena JRM, Louis R, Green JL, Rumack BH, et al. 2009 Annual report of the American Association of Poison Control Centers' national poison data system (NPDS): 27th annual report. Clinical Toxicology. 2010;48:979-1178.
  • 2. Small GW. Treatment of geriatric depression. Dep Anx Supp 1998; 1: 32–42.
  • 3. Deegan C, O'Brien K. Amitriptyline poisoning in a 2‐year old. Pediatric Anesthesia. 2006;16(2):174-7.
  • 4. Nelson, JC, Spyker, DA. Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014. American Journal of Psychiatry.2017;174,438–50.
  • 5. Biçer S, Sezer S, Çetindağ F, Kesikminare M, Tombulca N, Aydoğan G, et al. Acil Çocuk Kliniği 2005 Yılı Akut Zehirlenme Olgularının Değerlendirilmesi. Marmara Medical Journal 2007;20;12-20
  • 6. Hawton K, Bergen H, Simkin S, Cooper J, Waters, K, Gunnell D, et al. Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose. British Journal of Psychiatry. 2010; 196: 354–358.
  • 7. McKenzie MS, McFarland BH. Trends in antidepressant overdoses. Pharmacoepidemiol Drug Saf 2007; 16:513-23.
  • 8. Liebelt EL, Francis PD, Woolf AD. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Annals of emergency medicine. 1995;26:195-201.
  • 9. Singh N, Singh HK, Khan IA. Serial electrocardiographic changes as a predictor of cardiovascular toxicity in acute tricyclic antidepressant overdose. American journal of therapeutics. 2002;9:75-9.
  • 10. Woolf AD, Erdman AR, Nelson LS, Caravati EM, Cobaugh DJ, Booze LL, et al. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology. 2007; 45: 203–233.
  • 11. Mills KC. Tricyclic antidepressants. In Tintinalli JE, Kellen G, Stapczynski JS, editors. Emergency Medicine A Comprehensive Study Guide. 6th ed. New York: McGraw-Hill; 2004. pp. 1025-33
  • 12. Hevia JC, Antzelevitch C, Bárzaga FT, Sánchez MD, Balea FD, Molina RZ, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. Journal of the American College of Cardiology. 2006;47(9):1828-34.
  • 13. Linden C, Burns J. Poisoning and drug overdosage. In Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill; 2006. pp. 2581-93.
  • 14. Özköse Z, Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Human & experimental toxicology. 1999;18:614-8.
  • 15. Goksu S, Yildirim C, Kocoglu H, Tutak A, Oner U. Characteristics of acute adult poisoning in Gaziantep, Turkey. Journal of Toxicology: Clinical Toxicology. 2002;40:833-7.
  • 16. Yavuz S. Aydın S. Zehirlenme olgularının profili. Toksikoloji dergisi. 2003;1:47-52.
  • 17. Akköse Ş, Fedakar R, Bulut M, Çebiçci H. Zehirlenme olgularının beş yıllık analizi. Acil Tıp Dergisi. 2003;3:8-10.
  • 18. Harrigan RA, Brady WJ. ECG abnormalities in tricyclic antidepressant ingestion. The American journal of emergency medicine. 1999;17:387-93.
  • 19. Graudins A, Dowsett RP, Liddle C. The toxicity of antidepressant poisoning: is it changing? A comparative study of cyclic and newer serotonin‐specific antidepressants. Emergency Medicine. 2002;14:440-6.
  • 20. Mak KK, Ho CS, Zhang MW, Day JR, Ho RC. Characteristics of overdose and non-overdose suicide attempts in a multi-ethnic Asian society. Asian journal of psychiatry. 2013;6:373-9.
  • 21. Whyte IM, Dawson A, Buckley N. Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants. Qjm. 2003;96:369-74.
  • 22. Foulke GE. Identifying toxicity risk early after antidepressant overdose. The American journal of emergency medicine. 1995;13:123-6.
  • 23. Henry JA, Antao CA. Suicide and fetal antidepressant poisoning. Eur J Med 1992; 458–65.
  • 24. Høegholm A, Clementsen P. Hypertonic sodium chloride in severe antidepressant overdosage. Journal of Toxicology: Clinical Toxicology. 1991;29:297-8.
  • 25. DeBattista C. Antidepressant agents. In Katzung BG, Masters SB, Trevor AJ, editors. Basic & Clinical Pharmacology,12th ed. NY: McGraw Hill; 2012. pp.521-40.
  • 26. Benowitz NL. Tricyclic Antidepressants In Olson KR, editor. Poisoning and Drug Overdose. USA: Appleton and Lange; 1999. pp:310-12. 27. Unverir P, Atilla R, Karcioglu O, Topacoglu H, Demiral Y, Tuncok Y. A retrospective analysis of antidepressant poisonings in the emergency department: 11-year experience. Human & experimental toxicology. 2006;25:605-12.
  • 28. Stern TA, O'gara PT, Mulley AG, Singer DE, Thibault GE. Complications after overdose with tricyclic antidepressants. Critical care medicine. 1985;13:672-4.
  • 29. Groleau G, Jotte R, Barish R. The electrocardiographic manifestations of cyclic antidepressant therapy and overdose: a review. The Journal of emergency medicine. 1990;8:597-605.
  • 30. Phillips S, Brent J, Kulig K, Heiligenstein J, Birkett M, Group AS. Fluoxetine versus tricyclic antidepressants: a prospective multicenter study of antidepressant drug overdoses. The Journal of emergency medicine. 1997;15:439-45.
  • 31. Dökmeci İ.Trisiklik antidepresanlar. In Dökmeci İ, editor. Toksikoloji. 3rd ed. İstanbul: Nobel Tıp Kitapevleri; 2001. pp:414-5.
  • 32. Arranto C, Mueller C, Hunziker P, Marsch S, Eriksson U. Adverse cardiac events in ICU patients with presumptive antidepressant overdose. Swiss Medical Weekly. 2003;133:479–83
  • 33. Bosch TM, van der Werf TS, Uges DR, Ligtenberg JJ, Fijen Jw, Tulleken JE, et al. Antidepressants self-poisoning and ICU admissions in a university hospital in The Netherlands. Pharmacy World and Science. 2000;22:92-5.
  • 34. Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. American heart journal. 2005;150:1115-21.
  • 35. Hennessy S, Bilker WB, Knauss JS, Margolis DJ, Kimmel SE, Reynolds RF, et al. Cardiac arrest and ventricular arrhythmia in patients taking antipsychotic drugs: cohort study using administrative data. BMJ. 2002;325:1070.
  • 36. Acar G, Akkoyun M, Nacar A, Dirnak I, Yıldırım ÇG, Nur YM, et al. Evaluation of Tp-e interval and Tp-e/QT ratio in patients with rheumatoid arthritis. Turk Kardiyoloji Dernegi arsivi. 2014;42:29-34.
  • 37. Yamaguchi M, Shimizu M, Hidekazu I, Terai H, Uchiyama K, Kotaro O, et al. T wave peak-to-end interval and QT dispersion in acquired long QT syndrome: a new index for arrhythmogenicity. Clinical Science. 2003;105:671-6.
  • 38. Shimizu M, Ino H, Okeie K, Yamaguchi M, Nagata M, Hayashi K, et al. T‐peak to T‐end interval may be a better predictor of high‐risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clinical cardiology. 2002;25:335-9.
  • 39. Topilski I, Rogowski O, Rosso R, Justo D, Copperman Y, Glikson M, et al. The morphology of the QT interval predicts torsade de pointes during acquired bradyarrhythmias. Journal of the American College of Cardiology. 2007;49:320-8.
  • 40. Watanabe N, Kobayashi Y, Tanno K, Miyoshi F, Asano T, Kawamura M, et al. Transmural dispersion of repolarization and ventricular tachyarrhythmias. Journal of electrocardiology. 2004;37:191-200.
  • 41. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, et al. Tpe/QT ratio as an index of arrhythmogenesis. Journal of electrocardiology. 2008;41:567-74.
There are 40 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Original Articles
Authors

Can Yıldız This is me 0000-0001-8129-1468

Ramazan Köylü 0000-0002-7685-8340

Yahya Kemal Günaydın 0000-0002-9098-5346

Belgin Akıllı 0000-0001-9329-0964

Göknur Yıldız 0000-0002-2097-2531

Özge Turgay Yıldırım 0000-0002-6731-4958

Publication Date December 5, 2020
Submission Date October 6, 2020
Published in Issue Year 2020 Volume: 2 Issue: 3

Cite

APA Yıldız, C., Köylü, R., Günaydın, Y. K., Akıllı, B., et al. (2020). Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication. Eurasian Journal of Toxicology, 2(3), 57-63.
AMA Yıldız C, Köylü R, Günaydın YK, Akıllı B, Yıldız G, Turgay Yıldırım Ö. Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication. Eurasian J Tox. December 2020;2(3):57-63.
Chicago Yıldız, Can, Ramazan Köylü, Yahya Kemal Günaydın, Belgin Akıllı, Göknur Yıldız, and Özge Turgay Yıldırım. “Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication”. Eurasian Journal of Toxicology 2, no. 3 (December 2020): 57-63.
EndNote Yıldız C, Köylü R, Günaydın YK, Akıllı B, Yıldız G, Turgay Yıldırım Ö (December 1, 2020) Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication. Eurasian Journal of Toxicology 2 3 57–63.
IEEE C. Yıldız, R. Köylü, Y. K. Günaydın, B. Akıllı, G. Yıldız, and Ö. Turgay Yıldırım, “Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication”, Eurasian J Tox, vol. 2, no. 3, pp. 57–63, 2020.
ISNAD Yıldız, Can et al. “Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication”. Eurasian Journal of Toxicology 2/3 (December 2020), 57-63.
JAMA Yıldız C, Köylü R, Günaydın YK, Akıllı B, Yıldız G, Turgay Yıldırım Ö. Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication. Eurasian J Tox. 2020;2:57–63.
MLA Yıldız, Can et al. “Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication”. Eurasian Journal of Toxicology, vol. 2, no. 3, 2020, pp. 57-63.
Vancouver Yıldız C, Köylü R, Günaydın YK, Akıllı B, Yıldız G, Turgay Yıldırım Ö. Evaluation of the Changes in T Peak-T End Interval and T Peak-T End/QT Ratio in Tricyclic Antidepressant Intoxication. Eurasian J Tox. 2020;2(3):57-63.

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