Comparison of the efficacy of sodium bicarbonate therapy in anticholinergic drug poisoning causing negative cardiac effects

ABSTRACTComparison of the Efficacy of Sodium Bicarbonate Therapy in Anticholinergic DrugPoisoning Causing Negative Cardiac EffectsPoisoning with anticholinergic drugs are frequently seen in emergency services andlife-threatening. Anticholinergic drugs has serious cardiac side effects such as heart rate andritm abnormalities, and conduction delays. This is why it is quite important to determine thenegative cardiac effects of anticholinergic poisoning and the effectiveness of NaHCO3 therapyto cease them.The negative effects of the drugs causing anticholinergic poisoning signs and TCAs,and their response to NaHCO3 therapy were compared for this reason.Patients who had admitted to the Emergency Department of Cukurova UniversityFaculty of Medicine between July 7, 2005 and November 30, 2006 with long QT intervals oninitial ECGs because of poisoning with TCAs and other anticholinergic drugs included in thisprospective, case control study. The demographic, clinical and ECG data and laboratoryresults of the subjects were recorded and evaluated.Fifty-eight patients, 30 poisoned with TCAs and 28 with anticholinergic drugs,included in the study. Among all patients, 67.2% (n=39) were females of whom mean age was25.88±5.76. The majority of the patients were those who admitted to the EmergencyDepartment of Cukurova University Faculty of Medicine in the first 2-6 hours following drugintake. The most frequent agent causing poisoning was amitriptiline in TCA group while itwas antipsychotics in the other. Although tachycardia and elongation of QTc interval werecommon in all subjects, 64.9% (n=37) of them had QRS≥0.1s. There was no significantdifference between Na+, K+, Ca++, urine and blood pH results of the patients in both of thegroups after NaHCO3 therapy. However, while urine and blood pH with Na levels weresignificantly elevated, Ca++ levels were low in each group. All of the patients were observedin the emergency unit, no fatalities occured.Since NaHCO3 therapy completely ceased symptom and findings of the patients inboth of the groups, and any side effects due to therapy like hypertension metabolic acidosis,hypernatremia, hypopotassemia and hypocalemia did not occured, it is supposed to saystandart NaHCO3 therapy is a current effective and safe treatment in anticholinergic drugpoisoning.Key words: Anticholinergic Poisoning, Cardiac Effects, NaHCO3 TherapyVIII