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A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening

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Abstract

Sodium bicarbonate is a well-known antidote for tricyclic antidepressant (TCA) poisoning. It has been used for over half a century to treat toxin-induced sodium channel blockade as evidenced by QRS widening on the electrocardiogram (ECG). The purpose of this review is to describe the literature regarding electrophysiological mechanisms and clinical use of this antidote after poisoning by tricyclic antidepressants and other agents. This article will also address the literature supporting an increased serum sodium concentration, alkalemia, or the combination of both as the responsible mechanism(s) for sodium bicarbonate’s antidotal properties. While sodium bicarbonate has been used as a treatment for cardiac sodium channel blockade for multiple other agents including citalopram, cocaine, flecainide, diphenhydramine, propoxyphene, and lamotrigine, it has uncertain efficacy with bupropion, propranolol, and taxine-containing plants.

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Acknowledgments

The authors would like to thank Dr. Vassilios Bezzerides from the Boston Children’s Hospital Department of Cardiology, Division of Electrophysiology, for his assistance with this manuscript and shared expertise with respect to the electrophysiology of sodium channels.

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The authors declare that they have no competing interests.

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  1. Harvard Medical Toxicology Fellowship, Division of Emergency Medicine, Program in Medical Toxicology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Rebecca E. Bruccoleri & Michele M. Burns

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Bruccoleri, R.E., Burns, M.M. A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening. J. Med. Toxicol. 12, 121–129 (2016). https://doi.org/10.1007/s13181-015-0483-y

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