Evaluation of serum sodium changes in tricyclic antidepressants toxicity and its correlation with electrocardiography, serum pH, and toxicity severity

Authors
Farzad Gheshlaghi 1
Nastaran Eizadi-Mood 1
Soodabeh Emamikhah-Abarghooeii 2
Mahdi Arzani-Shamsabadi 2
1 Associate Professor, Isfahan University of Medical Sciences, Isfahan, Iran
2 General Physician, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Tricyclic antidepressants (TCAs) is a group of drugs used for the depression treatment. One of the effects of these drugs is Na (sodium) channel blocking ability causing cardiac complications such as ventricular tachycardia and Torsades de pointes Arrhythmia. Sodium bicarbonate is used for treatment of these complications which may have some effect on serum sodium levels. Considering no specific research on Na changes on these patients, the serum Na changes and its correlation with ECG changes, serum pH, and TCA toxicity severity were evaluated.
Materials and Methods: A prospective descriptive-analytic cross-sectional study was done on TCA-poisoning patients who were admitted in Noor hospital in Esfahan in last 2 years. Serum sodium levels, ECG changes, and TCA severity toxicity of 92 patients were evaluated five times during first 24 h of admission.
Results: A total of 92 patients were studied. The most common symptoms were conscious level changes (81.52%) and mydriasis (64.1%). Based on toxicity severity by these symptoms the patients were classified into three groups: 12% of the patients had mild toxicity, 50% moderate, and 38% severe toxicity. There were no significant differences in mean serum Na during the time. There was not found any correlation between serum Na level, and serum pH, ECG, and toxicity severity.
Conclusions: Using sodium bicarbonate in TCA-poisoning cases does not change the serum Na levels significantly.

Keywords

1. Flomenbaum N, Goldfrank L, Hoffman R, Hawland M, Lewiv H, Nelson L. Goldfrank 's Toxicologic Emergencies. New York: Mcgraw Hill; 2006. p. 1083-97.  Back to cited text no. 1
    
2. Tan C, Pillai S, Manning PG. Electrocardiographical case. A man found unconscious. Singapore Med J 2006;47:730-6.  Back to cited text no. 2
[PUBMED]    
3. Harrigan RA, Brady WJ. ECG Abnormalities in Tricyclie Antidepressant Ingestion. Am J Emerg Med 1997;17:387-97.  Back to cited text no. 3
    
4. Bradberry SM, Thanacoody HK, Wat BE, Thomas SH, Vale JA. Management of the cardiovascular complications of tricyclic antidepressant poisoning: Role of sodium bicarbonate. Toxicol Rev 2005;24:195-204.  Back to cited text no. 4
    
5. Chan HY, Chan YC, Lau FL. Reversal of Brugada electrocardiographic Pattern.With sodium bicarbonate solution after amitiriptyline overdose. Clin Toxicol 2008;46:892-6.  Back to cited text no. 5
[PUBMED]    
6. Miller J. Managing antidepression overdose. Emerg Med Serv 2004;33:113-9.  Back to cited text no. 6
[PUBMED]    
7. Bebarta VS. Waksman JC. Amitriptyline -induced Brugada pattern fails to respond to sodium bicarbonate. Clin Toxicol 2007;45:186-8.  Back to cited text no. 7
    
8. Woolf AD, Erdman AR, Nelson LS, Caravati EM, Cobaugh DJ, Booze LL, et al. Tricyclic antidepressant poisoning: An evidence - based consensus Guideline for out - of - hospital management . Clin Toxicol 2007;45:203-33.  Back to cited text no. 8
    
9. Olgun H, Yildirim ZK, Karacan M, Ceviz N. Clinical, electrocardiographic, and laboratory findings in children with amitriptyline intoxication. Pediatr Emerg Care 2009;25:170-3.  Back to cited text no. 9
[PUBMED]    
Advanced Biomedical Research
Volume 2012, October
October 2012
Pages 1-4