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Abstract
Two patients with cardiovascular and neurologic toxicity from intentional tricyclic
antidepressant overdose received bicarbonate infusions in association with hyperventilation
for alkalinization. Both patients developed profound alkalemia. One patient died,
and the other patient's alkalemia resolved prior to her death. Bicarbonate infusions
have become the standard of care for symptomatic tricyclic antidepressant toxicity.
Severe alkalemia (pH greater than 7.60) in other settings has been reported to correlate
with higher rates of mortality. Careful monitoring of the pH is imperative when bicarbonate
therapy is used. It is probably prudent to keep the pH level in the range 7.45 to
7.60. Capnography may also be useful in monitoring patients during alkalinization.
Keywords
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Article Info
Publication History
Accepted:
May 20,
1992
Received:
February 25,
1992
Identification
Copyright
© 1992 Published by Elsevier Inc.
