After amitriptyline overdose, a ventilated patient remains hypotensive with a QRS of 156 ms despite initial sodium bicarbonate. Sodium is 148 mmol/L

Question

After amitriptyline overdose, a ventilated patient remains hypotensive with a QRS of 156 ms despite initial sodium bicarbonate. Sodium is 148 mmol/L and potassium 3.3 mmol/L. Which biochemical target is commonly used when titrating further alkalinisation with toxicology input?

Accepted Answer

Arterial pH 7.50–7.55 while monitoring sodium and potassium

Answer

Serum bicarbonate above 40 mmol/L despite a near-normal arterial pH

Answer

Serum sodium above 165 mmol/L before alkalinisation is considered adequate

Answer

Arterial pH 7.35–7.45 while the QRS complex progressively narrows

Answer

Urine pH above 8.0 to enhance urinary trapping of tricyclics

Tricyclic antidepressant overdose — SCE Acute Medicine MCQ

After amitriptyline overdose, a ventilated patient remains hypotensive with a QRS of 156 ms despite initial sodium bicarbonate. Sodium is 148 mmol/L and potassium 3.3 mmol/L. Which biochemical target is commonly used when titrating further alkalinisation with toxicology input?