[Sodium bicarbonate infusion for intoxication with tricyclic antidepressives: recommended inspite of lack of scientific evidence].
Sodium bicarbonate infusion is widely recommended in textbooks for patients who present with self-poisoning from tricyclic antidepressives. Cardiac conduction disorders could also be treated or prevented by means of such an infusion. The scientific basis for these recommendations was investigated by using Medline to search for publications about clinical studies that supported the use of sodium carbonate; 111 articles were scrutinized. Observational studies and case reports mention a rapid improvement in hypotension and cardiac arrhythmias following the administration of sodium bicarbonate. Results from animal experiments are contentious; it is not clear whether alkalinisation or the administration of extra sodium causes the effect. Randomized studies in patients have not been carried out. As the toxicity of sodium bicarbonate is low, and its potential benefit appears to be high, we recommend its use, despite the lack of scientific evidence. No recommendations concerning dosing, concentration and the length of the therapy can be provided on the basis of the literature.
Vrijlandt
P J
PJ
Academisch Ziekenhuis, afd. Interne Geneeskunde, Intensive Care Beademing, Postbus 30.001, 9700 RB Groningen.
Bosch
T M
TM
Zijlstra
J G
JG
Tulleken
J E
JE
Ligtenberg
J J
JJ
van der Werf
T S
TS
D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000188:drug therapy*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy*; D007262:Infusions, Intravenous; D012189:Retrospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
D000929:Antidepressive Agents, Tricyclic; D017693:Sodium Bicarbonate