[mtoi]

48 yo patient admitted to ER with confusion and hallucination
Relevant hx - on antidepressant
Clinically - face flushed, mouth dry, bp 80/60, hr 100; ekg qrs 0.12 msec and frequent pvc
Treatment - iv hydration started
Which of the following agents will correct cardiac abnormalities
A potassium solution
B propranolol
C flumazenil
D sodium bicarbonate
E propranolol

 

[mtoi]

Culprit antidepressant – TCA – quinidine like effect on cardiac conduction system, potentially qrs and qt prolongation and cardiac dysarrythmias
Etiology of cardiac abnormalities – inhibition of fast sodium channels
Rx – hypertonic NaHCO3