How to treat a tricyclic antidepressant overdose. Know the dosage.

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How to treat a tricyclic antidepressant overdose. Know the dosage.

In a tricyclic antidepressant overdose, the heart’s sodium channels are blocked, which slows conduction and broadens the QRS complex, increasing the risk of dangerous rhythms. Sodium bicarbonate helps by increasing serum sodium and raising the blood’s pH. This reduces the drug’s blockade of the sodium channels and improves electrical conduction, which narrows the QRS and stabilizes the rhythm. The recommended dose is a bolus of 1 mEq/kg given intravenously as 8.4% sodium bicarbonate. If the QRS remains widened or the patient remains unstable, repeat boluses every few minutes (often 3–5 minutes) up to a reasonable total dose or until the QRS narrows and the patient stabilizes. Target a pH in the approximate range of 7.45–7.55, balancing effectiveness with the risk of alkalosis. After administration, closely monitor the ECG, arterial blood gas or venous pH, and electrolytes, and watch for signs of fluid overload or electrolyte disturbances.

In a tricyclic antidepressant overdose, the heart’s sodium channels are blocked, which slows conduction and broadens the QRS complex, increasing the risk of dangerous rhythms. Sodium bicarbonate helps by increasing serum sodium and raising the blood’s pH. This reduces the drug’s blockade of the sodium channels and improves electrical conduction, which narrows the QRS and stabilizes the rhythm.

The recommended dose is a bolus of 1 mEq/kg given intravenously as 8.4% sodium bicarbonate. If the QRS remains widened or the patient remains unstable, repeat boluses every few minutes (often 3–5 minutes) up to a reasonable total dose or until the QRS narrows and the patient stabilizes. Target a pH in the approximate range of 7.45–7.55, balancing effectiveness with the risk of alkalosis.

After administration, closely monitor the ECG, arterial blood gas or venous pH, and electrolytes, and watch for signs of fluid overload or electrolyte disturbances.

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