TCA Overdose
Call poison control.
- Check urine toxicology for co-ingestions esp. salicylates , acetaminophen.
- Get an EKG. Pay special attention to QRS, QTc, PR Beware QRS on EKG> 0.10 sec; VT, VF, myocardial depression can ensure (Q on T phenomenon)
- Evaluate if ICU admission is necessary: AMS, Respiratory depression, hypotension
- Telemetry
- If asymptomatic, get serial EKGs for 6 hours.
- NGT, lavage with 2 Liters NS, Ipecac contraindicated
- Activated charcoal 1g/kg within 2 hours of ingestion
- Alkalinize urine with 1NS & 2amps NaHCO3/I at 10-15 cc/kg/hr until urine output good, then D5W + 1-4 amps NaHCO3/I + 200 mEq KCl/I at 1-3x maintenance to give serum pH 7.5-7.55
- Do NOT use quinidine, procainamide if VT occurs. High risk for Torsades.
References:
1. Hospitalist Handbook, iPhone App