Tricyclic Antidepressant Toxicity Treated With Massive Sodium Bicarbonate

Kathleen E. Kane MD, Lehigh Valley Health Network
Bryan G. Kane MD, Lehigh Valley Health Network
Jessica E. Pierog DO, Lehigh Valley Health Network
J Ward Donovan MD
Tracey Helmick RN

Abstract

Tricyclic antidepressant (TCA) morbitity is primarily due to cardiac arrhythmias and hypotension, which become more refractory to treatment as acidosis progresses (Ann Emerg Med. 1985;14:1-9; Clin Toxicol. 2007;45:203-233; Flomenbaum N, Goldfrank L, Hoffman R, et al. Goldfrank's toxicologic emergencies. 8th ed. McGraw-Hill Companies, Inc, 2006). Early recognition and aggressive treatment are necessary for patient survival.