TCA overdose – beyond bicarbonate
A 38 yr old male presents to your ED, 2 hours after ingesting an unknown quantity of amitriptyline (TCA) with a GCS of 13, HR 130, BP96/50. How do you proceed?
Tag Sodium Channel Blocker
Phenytoin toxicity
Phenytoin intoxication can occur either with repeated supra therapeutic dosing or an acute overdose. Dose-dependent CNS depression occurs. Most presentations are benign and have good outcomes with supportive care. The main risk to patients is falling which can last days.
Cocaine-related Chest Pain
Cocaine is a recreational drug with sympathomimetic effects in additional to being a sodium channel blocker. Cocaine can induce acute coronary syndromes through vasoconstriction, atheroma rupture and/ or dissection
Sodium Channel Blocker Toxicity
AGENTS local anesthetic agents tricyclic antidepressants carbamazepine (in very high doses) dextropropoxyphene antiarrhythmics e.g. flecainide, quinine propanolol thioridizine phenothiazines (not usually clinically significant) amantidine NB. phenytoin and sodium valproate do not usually present with features of sodium channel blockade in…