Effect of hypertonic sodium bicarbonate in the treatment of moderate-to-severe cyclic antidepressant overdose
Related Experiment Videos
J R Hoffman1, S R Votey, M Bayer
1Department of Medicine, University of California, Los Angeles (UCLA) School of Medicine.
Insights
Intravenous hypertonic sodium bicarbonate (NaHCO3) effectively treated hypotension and QRS prolongation in cyclic antidepressant overdose patients. This treatment also improved mental status, significantly limiting major morbidity and mortality.
Area of Science:
- Emergency Medicine
- Clinical Toxicology
- Cardiology
Background:
- Cyclic antidepressant (CA) overdose presents significant risks, including cardiovascular instability and altered mental status.
- Intravenous hypertonic sodium bicarbonate (NaHCO3) is a potential treatment modality for managing these severe overdoses.
Purpose of the Study:
- To characterize the effects of intravenous hypertonic NaHCO3 on patients with moderate-to-severe CA overdose.
- To evaluate the impact of NaHCO3 on blood pressure, electrocardiographic parameters, and mental status.
- To assess major morbidity and mortality rates in CA overdose patients treated with NaHCO3.
Main Methods:
- Retrospective chart review of 91 patients diagnosed with CA overdose at UCLA Emergency Medicine Center (1980-1988).
- Analysis of patients who received NaHCO3 compared to a control group who did not.
- Evaluation of physiological and clinical responses to serum alkalinization with NaHCO3.
Main Results:
- Hypotension corrected in 96% of patients within 1 hour.
- QRS prolongation normalized in 80% of patients.
- Mental status improved in 47% of patients; one death occurred in a moribund patient on arrival.
- No complications were attributed to NaHCO3 administration.
Conclusions:
- Intravenous hypertonic NaHCO3 rapidly improves hypotension and QRS duration in most CA overdose patients.
- NaHCO3 administration, alongside supportive care, appears effective in limiting morbidity and mortality in severe CA overdose.
- Serum alkalinization with NaHCO3 is a valuable therapeutic intervention in managing cyclic antidepressant toxicity.
Abstract:
The objective of this study was to characterize the effect of intravenous hypertonic sodium bicarbonate (NaHCO3) administration in patients with moderate-to-severe cyclic antidepressant (CA) overdose. We reviewed charts of all 91 patients given the diagnosis of CA overdose in the University of California Los Angeles (UCLA) Emergency Medicine Center (EMC), who either died in the EMC or were admitted to the medical intensive care unit (MICU), and who received NaHCO3 in the EMC between 1980 and 1988. Twenty-four other patients with the same EMC diagnosis were admitted to the MICU during this period but did not receive NaHCO3. The response of blood pressure, electrocardiographic parameters, and mental status to serum alkalinization with NaHCO3 were evaluated. Major morbidity and mortality were recorded for all patients. Hypotension was corrected within 1 hour in 20 of 21 (96%) patients, QRS prolongation corrected in 39 of 49 (80%), and mental status improved in 40 of 85 (47%). There was one death, in a patient who was moribund on arrival to the EMC. No complications were attributable to the administration of NaHCO3. NaHCO3 seems to improve hypotension and normalize QRS duration rapidly in most patients treated, and improve mental status changes in almost one half. Serum alkalinization with NaHCO3, in conjunction with appropriate supportive care, seems to limit major morbidity and mortality effectively in patients with serious CA overdose.