The Effect of Adding Sodium Bicarbonate Drip Infusion to Its Bolus Administration in Patients with Tricyclic Antidepressant Poisoning: A Randomized Clinical Trial

Introduction: Tricyclic antidepressants (TCAs) are widely used in psychiatric and medical conditions and are a major cause of drug overdoses and fatal poisonings in many contries. Sodium bicarbonate administration is widely recommended as the first line treatment in TCAs intoxication but the best method of its administration has not been yet established therefore, we decided to compare the efficacy of drip infusion versus bolus administration of sodium bicarbonate in the treatment of TCAs poisoning. Method: In this randomized clinical trial, 80 patients who had TCAs poisoning and, had been admitted to ICU were selected and divided into two groups. Both groups received 2 meq/kg of sodium bicarbonate in one bolus dose then group 1 received drip infusion of 2 litters of sodium bicarbonate (1.4% solution) additionally for the first 24 hours until the resolution of ECG and ABGs abnormalities. Patients' outcomes in the two groups were compared. Results: More patients, after 8 hours, attaiened conscious in the drip infusion group. (p =0.012) and also this group reached significantly more normal ECG findings at 16 and 24 hours. (p = 0.013 and 0.005) There was no significant difference in ABGs outcomes between the two methods of administration. Conclusion: Although our results support the beneficial effects of adding bolus sodium bicarbonate on consciousness and electrocardiographic abnormalities in TCAs poisoning patients, to identify more effective ways of sodium bicarbonate administration, further trials are warranted.