Adult TCA Overdose: Initial treatment?

Adult TCA Overdose: Initial treatment?

• A. Normal Saline 1 L
• B. Sodium Bicarbonate 50 mEq IV/IO slow every 5 minutes
• C. Glucagon 1 mg
• D. Naloxone 0.4 mg

Answer: (A)

Stabilizing circulation with an isotonic IV fluid bolus is the first step in adult TCA overdose. These drugs can cause significant hypotension from alpha-1 blockade and direct cardiac depression, so giving a rapid normal saline bolus helps restore blood pressure and organ perfusion while you assess the patient and plan further treatment. Sodium bicarbonate is a key antidote for TCA toxicity, but it’s used specifically when there are signs of sodium channel blockade such as QRS widening or persistent hypotension, not as the very first move. Glucagon and naloxone target other overdose scenarios (beta-blocker/calcium-channel blocker toxicity and opioid toxicity, respectively) and aren’t indicated initially for TCA overdose.

Stabilizing circulation with an isotonic IV fluid bolus is the first step in adult TCA overdose. These drugs can cause significant hypotension from alpha-1 blockade and direct cardiac depression, so giving a rapid normal saline bolus helps restore blood pressure and organ perfusion while you assess the patient and plan further treatment. Sodium bicarbonate is a key antidote for TCA toxicity, but it’s used specifically when there are signs of sodium channel blockade such as QRS widening or persistent hypotension, not as the very first move. Glucagon and naloxone target other overdose scenarios (beta-blocker/calcium-channel blocker toxicity and opioid toxicity, respectively) and aren’t indicated initially for TCA overdose.