The use of Sodium Bicarbonate in Tricyclic antidepressant overdose
Date First Published:
July 5, 2005
Last Updated:
April 26, 2007
Report by:
Fawad Azam, Medical Student (MRI)
Search checked by:
Tom Bartram, MRI
Three-Part Question:
In [Tricyclic antidepressant overdose] does [Sodium Bicarbonate] improve [Arrythmias and hypotension]
Clinical Scenario:
A 28 year old female accountant is brouught in the the Emergency department. She has a glasgow coma scale of 8/15, her BP is 80/50 and her ECG shows signs of QRS prolongation. You wonder whether sodium bicarbonate will improve her condition
Search Strategy:
MEDLINE 1966-April 2007 PubMed Interface
Search Details:
(Antidepressant or tricyclic or amitriptyline or dothiepin or nortriptyline or imipramine or desipramine or protriptyline or clomipramine or doxepin) and (overdose or poisoning or self poisoning or toxic) and sodium bicarbonate
Outcome:
78 papers of which 1 recent review paper
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Management of the cardiovascular complications of tricyclic antidepressant poisoning : role of sodium bicarbonate. Bradberry SM. Thanacoody HK. Watt BE. Thomas SH. Vale JA 2005 UK | Adults, tricyclic ingestion. Experimental and clinical studies presented. | Review | Reducing cardiotoxicity | alkinisation with sodium bicarbonate is an effective treatment in the management of cardiovascular complications | Based on the limited studies available |
| Hypotension | bicarbonate should be administered after adequate fluid resuscitation |
Author Commentary:
Though it is generally accepted that sodium bicarbonate is an effective treatment for tricyclic overdose, the data available is from case reports and experimental studies on animals. This review presents all the known data well and includes all studies that can be found by current search strategies. A collaboration of experts concludes sodium bicarbonate is useful although there is no consensus on the mechanism of action or the relevant dose.
Bottom Line:
Sodium bicarbonate should be used to treat arrhythmia and hypotension in tricyclic overdose.
References:
- Bradberry SM. Thanacoody HK. Watt BE. Thomas SH. Vale JA. Management of the cardiovascular complications of tricyclic antidepressant poisoning : role of sodium bicarbonate.