Sodium Bicarbonate for TCA Toxicity
Patients with tricyclic antidepressant toxicity can present with arrhythmias and neurologic complications, such as seizures, because of the medication's sodium channel blockade and anticholinergic properties. Sodium bicarbonate should be used emergently to alkalinize the serum in certain scenarios. Indications include hypotension, arrhythmias, and QRS widening >100 msec on an electrocardiogram. (UpToDate; https://bit.ly/38OOaC0.)
Note that sodium bicarbonate is not indicated if a seizure occurs. Rather, administer a benzodiazepine in this case. Neurological complications result from the presynaptic reuptake inhibition of norepinephrine and serotonin in the central nervous system.
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Dr. Linis the founder, CEO, and editor-in-chief of Academic Life in Emergency Medicine (https://www.ALiEM.com) and a professor of emergency medicine at the University of California San Francisco with interests in health professions education and digital scholarship. Follow her on Instagram@MichelleLinMDand on Twitter@M_Lin.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.