Diltiazem Overdose — RACP Adult Medicine MCQ
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Correct answer: A — Give IV sodium bicarbonate boluses guided by QRS narrowing and haemodynamic response
The best answer is “Give IV sodium bicarbonate boluses guided by QRS narrowing and haemodynamic response”. Tricyclic cardiotoxicity causes fast sodium-channel blockade that worsens with acidaemia. IV sodium bicarbonate provides sodium loading and alkalinisation, with repeated dosing guided by QRS width, blood pressure and pH. High-dose insulin is used for severe calcium-channel or selected beta-blocker toxicity; flumazenil can precipitate seizures, and sodium-channel-blocking antiarrhythmics can worsen conduction.
Reference: NSW Agency for Clinical Innovation: Toxicology resources: https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/toxicology