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TCA Overdose

Dr Swapnil Pawar January 31, 2022 448

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    TCA Overdose
    Dr Swapnil Pawar

TCA Toxicity 

Blog Written by Dr Andrew Lam

ECG Findings in TCA Toxicity

  • Tachycardia
  • Widened QRS Complex
  • Deep S wave in Lead I and AvL
  • Tall R wave in AvR
  • In severe toxicity may also manifest as VF or VT

Management of TCA Toxicity

NaHCO3 in 1-2mmol/kg bolus followed by infusion

  • Indicated if widened QRS on ECG or presence of ventricular rhythm
  • Aim pH 7.5-7.55 and normalisation of QRS duration

Activated Charcoal

  • If ingestion within 1-2 hours, and patient alert and able to protect their own airway

IV Normal Saline

  • For treatment of hypotension secondary to TCA alpha antagonism
  • Vasopressors may be indicated in refractory hypotension


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