A patient consumed a large number of TCA pills during the depressive episode
and presented with altered sensorium, hypotension and high QRS complexes. What
should be the next step?
A. DC cardioversion
B. Start antiarrhythmic drug
C. NAHCO3
D. None of the above
Answer. C
Solution. The next step in this situation should be to administer sodium bicarbonate (NAHCO3).
The patient has likely ingested a large amount of tricyclic antidepressants (TCAs), which can
lead to a dangerous condition called tricyclic antidepressant toxicity. TCAs can cause a wide
range of symptoms, including altered sensorium, hypotension, and arrhythmias. One of the key
treatment strategies in TCA toxicity is to alkalize the urine to increase the elimination of the
drugs from the body. Sodium bicarbonate (NAHCO3) is commonly used for this purpose as it
can quickly raise the pH of the blood and urine, which can help to speed up the elimination of
the TCA and reduce the severity of symptoms. DC cardioversion and antiarrhythmic drugs may
be used in some cases of TCA toxicity to treat specific arrhythmias, but the initial step in most
cases should be to administer sodium bicarbonate to alkalize the urine and promote elimination
of the drugs.