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Tricyclic antidepressant toxicity — RCPSC EM MCQ

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HardToxicologyTricyclic antidepressant toxicityRCPSC EM

CTAS 1. A 44-year-old is found after amitriptyline overdose. BP is 82/46, GCS 7, QRS is 168 ms, and there are recurrent seizures. Sodium is 139 mmol/L and glucose is normal. What is the most appropriate initial management?

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Correct answer: A — IV sodium bicarbonate boluses

TCA toxicity with shock, seizures, and QRS widening is treated with IV sodium bicarbonate and supportive critical care.

Reference: Ontario Poison Centre TCA guidance; Goldfrank's Toxicologic Emergencies