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The use of Sodium Bicarbonate in Tricyclic antidepressant overdose

Three Part Question

In [Tricyclic antidepressant overdose] does [Sodium Bicarbonate] improve [Arrythmias and hypotension]

Clinical Scenario

A 28 year old female accountant is brouught in the the Emergency department. She has a glasgow coma scale of 8/15, her BP is 80/50 and her ECG shows signs of QRS prolongation. You wonder whether sodium bicarbonate will improve her condition

Search Strategy

MEDLINE 1966-April 2007 PubMed Interface
(Antidepressant or tricyclic or amitriptyline or dothiepin or nortriptyline or imipramine or desipramine or protriptyline or clomipramine or doxepin) and (overdose or poisoning or self poisoning or toxic) and sodium bicarbonate

Search Outcome

78 papers of which 1 recent review paper

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Bradberry et al
Adults, tricyclic ingestion. Experimental and clinical studies presented.ReviewReducing cardiotoxicityalkinisation with sodium bicarbonate is an effective treatment in the management of cardiovascular complicationsBased on the limited studies available
Hypotensionbicarbonate should be administered after adequate fluid resuscitation


Though it is generally accepted that sodium bicarbonate is an effective treatment for tricyclic overdose, the data available is from case reports and experimental studies on animals. This review presents all the known data well and includes all studies that can be found by current search strategies. A collaboration of experts concludes sodium bicarbonate is useful although there is no consensus on the mechanism of action or the relevant dose.

Clinical Bottom Line

Sodium bicarbonate should be used to treat arrhythmia and hypotension in tricyclic overdose.


  1. Bradberry SM. Thanacoody HK. Watt BE. Thomas SH. Vale JA Management of the cardiovascular complications of tricyclic antidepressant poisoning : role of sodium bicarbonate. Toxicol Rev. 2005;24(3):195-204.