TCA Overdose

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