REBEL Core Cast 109.0 – Na Channel Blocker Poisoning
REBEL Cast
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Common Overdose Drugs and ECG Changes with Sodium Channel Blockade
This chapter discusses the prevalence of Diphon hydromine and tricyclic anti-depressant overdoses and highlights the ECG changes seen with sodium channel blocking drugs, including QRS widening and specific manifestations.
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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. ... 
