What is the recommended treatment for TCA overdose?

The recommended treatment for tricyclic antidepressant (TCA) overdose is sodium bicarbonate. In cases of TCA toxicity, one of the primary concerns is metabolic acidosis and cardiac arrhythmias, particularly in the setting of QRS widening on the ECG. Sodium bicarbonate works effectively to counteract the metabolic acidosis and helps to stabilize the cardiac membrane, thereby reducing the risk of arrhythmias.

When administered, sodium bicarbonate alkalinizes the serum and can effectively narrow the QRS complex on the ECG, which is a key factor in preventing life-threatening cardiac complications. This treatment is especially beneficial in patients who exhibit significant toxicity symptoms, including seizures or severe cardiovascular instability.

Activated charcoal is often used in the management of many poisonings and can be effective if administered shortly after ingestion to reduce absorption, but it does not specifically address the toxic effects of TCAs like sodium bicarbonate does. Flumazenil is a benzodiazepine antagonist and is contraindicated in TCA overdose due to the risk of seizures and further complications. Fomepizole is specifically used for ethylene glycol or methanol poisoning and does not play a role in TCA overdose management.

Thus, sodium bicarbonate's ability to correct acidosis,