Question

A patient consumed a large number of TCA pills during the depressive episode and presented with altered sensorium, hypotension, and high QRS complexes. What should be the next step?

• A. DC cardioversion
• B. Start antiarrhythmic drug
• C. NAHCO3
• D. None of the above

Hint:

In cases of TCA toxicity, sodium bicarbonate helps to alkalize the blood and urine, which can reduce the effects of the drug and promote its elimination.

Answer 1

The Correct Option is C

The next step in this situation should be to administer sodium bicarbonate (NAHCO3). The patient has likely ingested a large amount of tricyclic antidepressants (TCAs), which can lead to a dangerous condition called tricyclic antidepressant toxicity. TCAs can cause a wide range of symptoms, including altered sensorium, hypotension, and arrhythmias. One of the key treatment strategies in TCA toxicity is to alkalize the urine to increase the elimination of the drugs from the body. Sodium bicarbonate (NAHCO3) is commonly used for this purpose as it can quickly raise the pH of the blood and urine, which can help to speed up the elimination of the TCA and reduce the severity of symptoms.
DC cardioversion and antiarrhythmic drugs may be used in some cases of TCA toxicity to treat specific arrhythmias, but the initial step in most cases should be to administer sodium bicarbonate to alkalize the urine and promote elimination of the drugs.