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Ten Minute Toxicology- Sodium Channel Blockade

Ten Minute Toxicology- Sodium Channel Blockade. Russell Berger, MD Co-Director of Medical Toxicology Cambridge Health Alliance. Pathogenesis of Na Channel Blockade. Examples of Na Channel Blockers. TCA’s Benadryl Carbamazepine Propanalol Darvocet Chloroquine Quinine Many others….

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Ten Minute Toxicology- Sodium Channel Blockade

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  1. Ten Minute Toxicology-Sodium Channel Blockade Russell Berger, MD Co-Director of Medical Toxicology Cambridge Health Alliance

  2. Pathogenesis of Na Channel Blockade

  3. Examples of Na Channel Blockers TCA’s Benadryl Carbamazepine Propanalol Darvocet Chloroquine Quinine Many others…

  4. Recognition of Na Channel blockade • Is QRS > 100ms • Is R wave in AVR > 3mm • Is there a significant change in the patient’s QRS complex with respect to their baseline QRS (established on prior ekgs)?

  5. R wave in aVR

  6. Why we care… • QRS > 120 = Seizures • QRS >160 = Vtach and Vfib…death

  7. Treatment • Na Bicarbonate: • Bolus with amps of Na bicarb until drip is available -3 amps of Na bicarb in D5W as drip LIMITATION: Serum pH

  8. Treatment Continued When serum pH limit is reached Hypertonic Saline -4-5cc/kg boluses PRN continued seizures or ventricular dysrhtymias. LIMITATION: Serum Sodium

  9. Treatment Continued When serum Na limit is reached Intralipid 20 % intralipid solution 1.5 cc/kg bolus 0.25cc/kg/min as a drip x1 hour Limitation: Interpretation of basic lab parameters 2/2 lipemia; pancreatitis

  10. Finally • Consider transfer for ECMO or IABP therapy with refractory severe toxicity manifest by status epilepticus, refractory hypotension, or dysrhythmias.

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