Drugs with Na Channel Blocking Propertiesĭozens of fatal poisonings from toxic alcohols are reported to poison centers each year. In addition to use in treatment of poisonings with sodium channel blocking activity, sodium bicarbonate may also be used as adjunctive therapy in poisonings due to methanol, ethylene glycol, and salicylates. These cardiotoxins are responsible for more fatal dysrhythmias annually than any other class of medications. Together they comprise perhaps the largest group of cardiotoxic agents. How should sodium bicarbonate be administered?ĭrugs and toxins that act as sodium channel antagonists include agents listed in List 1.By what mechanism does sodium bicarbonate work?.What are the indications for the use of sodium bicarbonate in toxicology?.She is discharged to the psychiatry service. After 36 hours the patient is extubated and is awake and alert with resolution of hypotension. Her arterial pH increases to greater than 7.50 but her QRS complexes remain narrow and she does not develop any more dysrhythmias. Over the course of the next several hours, the patient receives ten ampules of sodium bicarbonate. However, ten minutes later the QRS abnormalities recur. Sodium bicarbonate is administered as a bolus of 1 mEq/kg and a repeat EKG reveals narrowing of the QRS complexes. Intravenous fluids and norepinephrine are administered for hypotension.

An EKG shows sinus tachycardia with wide ventricular complexes (QRS interval > 160 msec) with a prominent R wave in lead aVR. Fifty grams of activated charcoal are instilled by NG tube into the stomach. She undergoes immediate endotracheal intubation with moderate hyperventilation, and receives a 2 liters bolus of normal saline. Her blood pressure is 90 mm Hg by palpation and her heart rate is 110 beats/min. She is somnolent with a Glasgow coma score (GCS) of 8. Case presentationĪ 28 year-old woman with a history of depression is brought to the emergency department approximately one hour after an overdose of amitriptyline. The rationale for its use can be divided into several distinct categories, and its method of administration depends on its clinical indication. Sodium bicarbonate administration is a suggested treatment modality for a variety of toxicologic and nontoxicologic conditions such as poisonings by tricyclic antidepressants, toxic alcohols, and salicylates, and other conditions such as hyperkalemia.

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