REBEL Core Cast 109.0 – Na Channel Blocker Poisoning
REBEL Cast
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QR Restoration and Sodium Channel Blockade
This chapter explores the significance of QR restoration in poisoning, focusing on tricyclic antidepressants and sodium channel blockers. It discusses the findings of a key tox paper from 1985 and emphasizes the importance of considering sodium channel blockade as a differential diagnosis for widened QRS intervals.
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Take Home Points: In the context of poisoning, a “wide QRS” is anything greater than 100 milliseconds. A newly “wide QRS”, especially with hemodynamic instability, should prompt consideration of sodium channel blockade and not ventricular tachycardia. Treatment is guided by administration of sodium-bicarbonate. Recall that the resultant alkalemia driven by sodium-bicarbonate will shift potassium intracellularly. ... 
