Thursday November 19, 2009

Q: Serum alkalinization with intravenous sodium bicarbonate has been the mainstay of therapy in (CA) cyclic antidepressants (amitriptyline, desipramine, imipramine, nortriptyline, doxepin, clomipramine, and protriptyline) overdose. What is the cutoff limit of QRS complex for use of intravenous sodium bicarbonate therapy?

Answer: A QRS of 100 milliseconds or greater is generally use as the cut off for intravenous sodium bicarbonate. Beside alkalinization, sodium loading may be the most important factor in the reversal of the symptoms of cyclic antidepressant toxicity. IV normal saline are indicated for CA-induced hypotension.