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Related Experiment Videos

Does a sodium-free buffer affect QRS width in experimental amitriptyline overdose?

C K Stone1, C M Kraemer, R Carroll

  • 1Department of Emergency Medicine, East Carolina University School of Medicine, Greenville, North Carolina, USA.

Annals of Emergency Medicine
|July 1, 1995
PubMed
Summary
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Altering pH with tromethamine reversed QRS widening in experimental amitriptyline overdose. This study shows that increasing pH alone can resolve cardiac toxicity from amitriptyline.

Area of Science:

  • Pharmacology
  • Toxicology
  • Cardiology

Background:

  • Amitriptyline overdose can cause significant cardiac toxicity, characterized by QRS widening.
  • Tromethamine is a non-sodium buffering agent used to manage acid-base disturbances.

Purpose of the Study:

  • To investigate the effect of pH alteration on QRS width in a canine model of amitriptyline overdose.
  • To assess the efficacy of tromethamine in reversing amitriptyline-induced cardiac toxicity.

Main Methods:

  • A prospective, nonblinded trial was conducted on pentobarbital-anesthetized adult mongrel dogs.
  • Dogs received amitriptyline overdose, and tromethamine was administered to raise pH to 7.50 +/- 0.04 at two toxicity points.
  • pH and QRS width were measured before and after tromethamine administration; data analyzed using non-linear regression.

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Main Results:

  • Tromethamine administration increased pH and significantly decreased QRS width in both toxicity scenarios.
  • At toxicity 1, pH increased from 7.32 to 7.51, and QRS width decreased from 11.6 mm to 8.4 mm.
  • At toxicity 2, pH increased from 7.40 to 7.49, and QRS width decreased from 10.6 mm to 9.7 mm. A significant correlation (P = .0001) was found between increased pH and decreased QRS width.

Conclusions:

  • pH alteration alone, achieved with tromethamine, effectively reversed QRS widening in experimental amitriptyline overdose.
  • These findings suggest that managing acid-base balance is crucial in treating amitriptyline-induced cardiac toxicity.