Too much of a good thing: Bicarbonate toxicity following treatment of sodium channel blocker overdose.
bicarbonate
overdose
sodium channel blockade
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
07
04
2022
received:
27
03
2022
accepted:
11
04
2022
pubmed:
28
4
2022
medline:
20
7
2022
entrez:
27
4
2022
Statut:
ppublish
Résumé
Although sodium bicarbonate can be a life-saving antidote for patients with overdoses resulting in sodium channel blockade, there has been a concerning rise in cases referred to the Poisons Information Centre where inappropriately large doses of bicarbonate have been used resulting in iatrogenic harm. We present a series of three clinical cases where excessive bicarbonate was used to treat poisonings and discuss our approach to managing cardiotoxicity secondary to sodium channel blockade. Serial blood gas analysis should be performed when using bicarbonate to ensure pH targets are met and severe alkalaemia, hypernatraemia and hypokalaemia are avoided. We encourage clinicians to contact the Poisons Information Centre (13 11 26) or their local clinical toxicologist when managing patients with life-threatening sodium channel blockade.
Identifiants
pubmed: 35475321
doi: 10.1111/1742-6723.13995
doi:
Substances chimiques
Bicarbonates
0
Sodium Channel Blockers
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
639-641Informations de copyright
© 2022 Australasian College for Emergency Medicine.
Références
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Australasian College for Emergency Medicine. Curriculum 2022 Fellowship of the Australasian College for Emergency Medicine. Melbourne: Australasian College for Emergency Medicine, 2021.
Lazar A, Lenkey N, Pesti K, Fodor L, Mike A. Different pH-sensitivity patterns of 30 sodium channel inhibitors suggest chemically different pools along the access pathway. Front. Pharmacol. 2015; 6: 210.
Love JN, Howell JM, Newsome JT, Skibbie DF, Dickerson LW, Henderson KJ. The effect of sodium bicarbonate on propranolol-induced cardiovascular toxicity in a canine model. J. Toxicol. Clin. Toxicol. 2000; 38: 421-8.