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Tricyclic antidepressant overdose — DIPIMC MCQ

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HardMedical EmergenciesTricyclic antidepressant overdoseDIPIMCDipIMC

A young adult is brought in after a deliberate overdose of amitriptyline. He is drowsy and hypotensive with dilated pupils, and his ECG shows a QRS duration of 140 ms.

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Give intravenous sodium bicarbonate and support the airway

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

Tricyclic antidepressant toxicity causes sodium-channel blockade with QRS widening and a risk of malignant arrhythmia, and the specific treatment for a broad QRS or hypotension is intravenous sodium bicarbonate while supporting the airway. Flumazenil (A) is dangerous here and addresses the wrong toxidrome. A wide QRS in a poisoned patient with anticholinergic features should prompt sodium bicarbonate.

Reference: TOXBASE; JRCALC Clinical Guidelines