A young female on antidepressants presents to the emergency with altered sensorium and hypotension. ECG reveals wide QRS complexes and right axis detion. What is the next best step?
This patient was most likely on Tricyclic antidepressants and it appears to be a case of Tricyclic antidepressants overdosage as the patient is experiencing arrhythmias, hypotension and has also developed altered sensorium. The mainstay of treatment in TCA induced cardio toxicity is intravenous sodium bicarbonate. It is used if the QRS interval is prolonged (usually more than 100 milliseconds) and can reverse the toxic effects of TCAs. Because of large volume of distribution and high protein binding of TCAs, Hemodialysis is not effective. Fuher flumazenil and fomepizole have no role.
Sodium bicarbonate
Hemodialysis
Fomepizole
Flumazenil
Mood Disorders