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Tricyclic antidepressant overdose — RCPSC EM MCQ

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HardToxicologyTricyclic antidepressant overdoseRCPSC EM

After amitriptyline overdose, a patient has seizure, BP 82/44 mmHg and QRS 158 ms. What is the immediate antidysrhythmic treatment?

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Reveal the answer and explanation

Correct answer: BGive IV sodium bicarbonate and reassess cardiac conduction and systemic perfusion

Explanation lettering: E = shown as A · D = shown as B · B = shown as D · A = shown as E

D is correct for severe TCA sodium-channel blockade. E can worsen conduction and seizures. A adds sodium-channel blockade. B provokes seizures and has no mechanistic benefit. C is ineffective because of high protein binding and distribution volume.

Reference: Ontario Poison Centre, Tricyclic antidepressant overdose approach: https://www.ontariopoisoncentre.ca/siteassets/pdfs/english/tricyclicoverdoseapproach.pdf