For Tricyclic Antidepressant overdose, what is the initial treatment specified in the protocol?

The initial treatment for a Tricyclic Antidepressant (TCA) overdose is sodium bicarbonate administered at a dosage of 1 mEq/kg intravenously push (IVP). This choice is based on the fact that TCA overdose can lead to metabolic acidosis and significant cardiovascular toxicity, including arrhythmias. Sodium bicarbonate helps to alkalinize the blood, which can stabilize cardiac conduction and mitigate the risk of fatal arrhythmias caused by the overdose.

Alkalinization can also enhance the elimination of the drug from the body, as TCA medications are weak bases. By increasing the pH, sodium bicarbonate decreases the reabsorption of the drug in the renal tubules, promoting its excretion. This makes sodium bicarbonate not only a therapeutic intervention targeting the immediate life-threatening effects of TCA overdose but also a means to facilitate faster elimination of the drug.

In contrast, while glucagon can be useful in certain cases of beta-blocker and calcium channel blocker overdoses, it does not specifically address the unique complications arising from TCA overdoses. Calcium chloride is typically utilized for hypocalcemia or to stabilize cardiac function in specific scenarios but is not indicated as an initial treatment for TCA overdose. Similarly, while providing