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Tricyclic antidepressant overdose — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseTricyclic antidepressant overdoseSCE Acute Medicine

A 49-year-old woman is assessed on the acute medical unit. She is hypotensive after amitriptyline overdose. ECG shows QRS duration 150 ms and right-axis deviation. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: A — Give intravenous sodium bicarbonate

Give intravenous sodium bicarbonate is the best answer because TCA cardiotoxicity with QRS widening is treated with intravenous sodium bicarbonate. Start therapeutic anticoagulation while awaiting imaging is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Activated charcoal does not treat established sodium-channel blockade.

Reference: Toxbase; BNF