A young female on antidepressants presents to the emergency with altered sensorium and hypotension. ECG reveals wide QRS complexes and right axis detion. Next best step for the management of this patient:
Sodium bicarbonate
Hemodialysis
Fomepizole
Flumazenil
Ans: A. Sodium bicarbonate(Ref Harrison 19/e p172)Typically suggest a diagnosis of tricyclic antidepressant poisoning.Antidote for TCA poisoning - Sodium bicarbonate.Administered IV 100 mEq (1-2 mEq/kg), and repeated every few minutes until BP improves and QRS complexes begin to narrow.Hemodialysis should not be used since TCAs are highly protein-bound with large volume of distribution.