PREHOSPITAL CARE

Review of prehospital sodium bicarbonate use for cyclic antidepressant overdose

T Calkins¹, T C Chan¹, R F Clark¹, B Stepanski² and G M Vilke¹

¹ Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, USA
² County of San Diego Emergency Medical Services, Department of Health Services, University of California San Diego Medical Center

Correspondence to:
Correspondence to:
Dr G M Vilke, Department of Emergency Medicine, UC San Diego Medical Center, 200 West Arbor Drive no 8676, San Diego, CA 92103, USA;
gmvilke{at}ucsd.edu

Objective: To describe the clinical presentation of patients with cyclic antidepressant (CA) and use of sodium bicarbonate (NaHCO₃) in the treatment of this overdose in the prehospital setting.

Methods: A three year retrospective observational review of records was performed using the San Diego County Quality Assurance Network database for prehospital providers. All adult patients who were treated with NaHCO₃ by paramedics for a CA overdose were included. Demographic data, presenting cardiovascular and neurological symptoms, paramedic treatments, and any changes in status were reviewed.

Results: Twenty one patients were treated by paramedics with NaHCO₃ for CA overdose. Seventeen patients (80%) presented with mental status changes, including 11 presenting with a GCS<8. Seven of the 21 (33%) presented with a cardiac arrhythmia expected to possibly respond to NaHCO₃ treatment. Seven of the 21 (33%) were hypotensive, and five (24%) patients had reported seizure activity. Only 2 of the 21 patients (10%) treated with NaHCO₃ had recorded improvements after administration of the drug, while the other 19 remained stable without any deterioration. Sixteen of 21 patients (76%) were given NaHCO₃ for indications on standing order, while five patients were treated outside the standing order indications by base physician order with none of the five patients having any change in status ater treatment.

Conclusions: After prehospital NaHCO₃ use in patients with CA overdose, there were no complications reported, two patients improved in status and the others remained unchanged. Base hospital physician orders of NaHCO₃ for indications beyond the standing orders were not associated with changes in patient status.

Keywords: cyclic antidepressant; sodium bicarbonate

Abbreviations: CA, cyclic antidepressant; GCS, Glasgow coma score; BHP, base hospital physician

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