Question

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

Hint:

In cases of TCA toxicity, sodium bicarbonate helps to alkalize the blood and urine, which can reduce the effects of the drug and promote its elimination.

Answer 1

The Correct Option is C

To address the question regarding the management of a patient who has consumed a large number of Tricyclic Antidepressant (TCA) pills and is presenting with symptoms such as altered sensorium, hypotension, and high QRS complexes, we need to consider the pharmacological effects and recommended treatment protocols for TCA overdose.

1. Understanding TCA Overdose:
   • Tricyclic Antidepressants are known to cause cardiotoxic effects which include prolonged QRS interval, hypotension, and arrhythmias.
   • In overdose situations, TCAs can also lead to altered sensorium due to central nervous system toxicity.
2. Preferred Treatment for TCA Overdose:
   • The key treatment for TCA overdose, especially when there are cardiac symptoms such as a widened QRS complex, is the administration of sodium bicarbonate (NaHCO₃).
   • Sodium bicarbonate helps by increasing serum pH and extracellular sodium which counteracts the cardiac sodium channel blockade caused by TCAs.
3. Evaluation of Options:
   • DC cardioversion: Typically used for managing acute arrhythmias but not first-line treatment for TCA toxicity-induced arrhythmias.
   • Start antiarrhythmic drug: Use of antiarrhythmics is not indicated initially; sodium bicarbonate is preferred due to its direct mechanism in counteracting TCA effects.
   • NAHCO₃: Correct option as it specifically addresses the cardiotoxic effects such as QRS widening and complications from TCA overdose.
   • None of the above: Incorrect, as specific intervention (NaHCO₃) is required.

Based on the above reasoning, the correct answer is: NaHCO₃.