sodium-bicarbonate and Brugada-Syndrome

Topics: Adult; Brugada Syndrome; Cholinergic Antagonists; Diphenhydramine; Electrocardiography; Humans; Male; Sodium Bicarbonate; Suicide, Attempted

Topics: Adult; Anti-Arrhythmia Agents; Brugada Syndrome; Electrocardiography; Flecainide; Humans; Magnesium; Male; Poisoning; Sodium Bicarbonate

A Brugada electrocardiographic pattern (BEP) associated with tricyclic antidepressant (TCA) overdose has been reported rarely, but its reversal by sodium bicarbonate has not been described previously. We reported a case of amitriptyline overdose induced Type 1 BEP which was reversed by 150 mEq of intravenous sodium bicarbonate.

Topics: Adult; Amitriptyline; Antidepressive Agents, Tricyclic; Brugada Syndrome; Drug Overdose; Electrocardiography; Humans; Male; Sodium Bicarbonate; Suicide

Topics: Amitriptyline; Animals; Antidepressive Agents, Tricyclic; Brugada Syndrome; Electrocardiography; Humans; Saline Solution, Hypertonic; Sodium Bicarbonate

This report describes a Brugada electrocardiographic pattern after tricyclic antidepressant intoxication that fails to resolve following sodium bicarbonate treatment. A 50-year-old male ingested 13.6 grams of amitriptyline and presented in cardiopulmonary arrest. After initial resuscitation, the patient developed a Brugada electrocardiographic pattern. The pattern persisted despite intravenous administration of 700 mEq of sodium bicarbonate. Five hours after the last dose of sodium bicarbonate and 18 hours after initial presentation, the Brugada pattern resolved. No co-ingestants were ingested and an ischemic pattern was not seen on electrocardiogram. The serum amitriptyline level was >1000 ng/ml. Response of the tricyclic-induced Brugada pattern to sodium bicarbonate has not been previously reported.

Topics: Amitriptyline; Antidepressive Agents, Tricyclic; Brugada Syndrome; Drug Overdose; Electrocardiography; Humans; Male; Middle Aged; Sodium Bicarbonate; Sodium Channels; Treatment Failure

Direct-air ventilation, external cardiac compression, and external defibrillation are established techniques for patients who unexpectedly develop cardiac arrest. The proper use of drugs can increase the incidence of successful resuscitation. Intracardiac adrenaline (epinephrine) acts as a powerful stimulant during cardiac standstill and, in addition, converts fine ventricular fibrillation to a coarser type, more responsive to electrical defibrillation. Routine use of intravenous sodium bicarbonate is recommended to combat the severe metabolic acidosis accompanying cardiac arrest. Lidocaine is particularly useful when ventricular fibrillation or ventricular tachycardia tends to recur. Analeptics are contraindicated, since they invariably increase oxygen requirements of already hypoxic cerebral tissues. The following acrostic is a useful mnemonic for recalling the details of the management of cardiac arrest in their proper order: A (Airway), B (Breathing), C (Circulation), D (Diagnosis of underlying cause), E (Epinephrine), F (Fibrillation), G (Glucose intravenously), pH (Sodium bicarbonate), I (Intensive care).

Topics: Acidosis; Arrhythmias, Cardiac; Bicarbonates; Brugada Syndrome; Cardiac Conduction System Disease; Critical Care; Drug Therapy; Electric Countershock; Epinephrine; Glucose; Heart Arrest; Heart Conduction System; Humans; Intensive Care Units; Lidocaine; Resuscitation; Sodium Bicarbonate; Tachycardia, Ventricular; Ventricular Fibrillation

Topics: Arrhythmias, Cardiac; Brugada Syndrome; Carbon Dioxide; Cardiac Conduction System Disease; Heart Conduction System; Humans; Sodium Bicarbonate