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Tricyclic antidepressant poisoning — RCPSC EM MCQ

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HardToxicologyTricyclic antidepressant poisoningRCPSC EM

A 58-year-old taking amitriptyline is found after an overdose. He is hypotensive, has recurrent seizures, QRS is 168 ms, and venous pH is 7.21. What is the most appropriate initial management?

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Correct answer: B — Intravenous sodium bicarbonate boluses targeting QRS narrowing and alkalinisation

TCA poisoning with hypotension, seizures and QRS widening is treated with sodium bicarbonate; flumazenil and physostigmine can worsen outcomes.

Reference: Canadian poison centre guidance; toxicology emergency standards