What is the dose of Sodium Bicarbonate for adult using base hospital order for Tricyclic Poisoning?

• A. Sodium Bicarbonate 1 mEq/kg IV/IO
• B. Sodium Bicarbonate 50 mEq IV/IO
• C. Sodium Bicarbonate 2 mEq/kg IV/IO
• D. Sodium Bicarbonate 0.5 mEq/kg IV/IO

Answer: (A)

In tricyclic antidepressant poisoning, the goal of sodium bicarbonate treatment is to reverse the drug’s dangerous effects on the heart by alkalinizing the serum and increasing the extracellular sodium. Giving a bolus of sodium bicarbonate in a weight-based amount ensures this sodium load and pH shift are achieved safely for adults. The recommended dosing is 1 mEq/kg given IV or IO, usually as a bolus, and it can be repeated every 3–5 minutes if the QRS remains widened or the patient remains unstable. This approach helps reduce sodium channel blockade in the heart and can improve conduction and blood pressure.

Why this dose fits best: using a weight-based amount ensures the patient receives an effective sodium load without overdoing it. A fixed 50 mEq dose can be too low for larger adults and may not achieve the desired effect, while a higher dose like 2 mEq/kg risks excess alkalinization and electrolyte imbalance. A smaller 0.5 mEq/kg dose is often insufficient to counteract severe sodium channel blockade in many adults.

Additional context: treatment is continued with monitoring of ECG, serum electrolytes, and pH, and repeated boluses are guided by clinical response, aiming for QRS narrowing and improved hemodynamics.