Evidence map›Paper›PMID 32737857›Full record

Observational studyJournal of medical toxicology : official journal of the American College of Medical Toxicology2021

Antidotal Sodium Bicarbonate Therapy: Delayed QTc Prolongation and Cardiovascular Events.

Siri Shastry, Judson Ellis, George Loo, Rajesh Vedanthan, Lynne D Richardson, Alex F Manini

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.9field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 8 citations in OpenAlex.

  1. Article
  2. Don't Throw the Sodium Bicarbonate Out with the Correlation.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2021
    Article
  3. In Response: Don't Throw the Sodium Bicarbonate Out with the Correlation.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2021
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

Siri ShastryDepartment of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, 3 East 101st Street, 2nd Floor, New York, NY, 10029, USA. Siri.Shastry@mountsinai.org.ORCID 0000-0002-4618-5800
Judson EllisBrown University, Providence, RI, USA.
George LooDepartment of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, 3 East 101st Street, 2nd Floor, New York, NY, 10029, USA.
Rajesh VedanthanDepartment of Population Health, New York University, New York, NY, USA.
Lynne D RichardsonDepartment of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, 3 East 101st Street, 2nd Floor, New York, NY, 10029, USA.
Alex F ManiniDivision of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine, Elmhurst Hospital Center, New York, NY, USA.
Mount Sinai Hospital · USBrown University · USElmhurst Hospital Center · USNew York University · US

Funding

MOUNT SINAI MEDICAL SCIENTIST TRAINING PROGRAMT32GM007280 · NIGMS · MOUNT SINAI SCHOOL OF MEDICINE OF NYU · PI BARON, MARGARET H · 1985 to 2021
$22.8M
Predicting medical consequences of novel fentanyl analog overdose using the Toxicology Investigators Consortium (TOXIC) R01DA048009 · NIDA · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI Alex Francis Manini · 2020 to 2026
$6.7M
Prevention of the cardiovascular medical consequences of drug overdoseR01DA037317 · NIDA · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI MANINI, ALEX FRANCIS · 2014 to 2018
$3.6M
Mount Sinai Clinician Scientist Training Program in Emergency Care ResearchT32HL129974 · NHLBI · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI RICHARDSON, LYNNE D. · 2016 to 2020
$2.3M
NHLBI NIH HHS 1T32 HL129974-01NHLBI NIH HHS T32 HL129974NIDA NIH HHS R01 DA037317NIDA NIH HHS R01 DA048009NIGMS NIH HHS T32 GM007280
6 · The paper itself

Abstract

backgroundSodium bicarbonate therapy (SBT) is currently indicated for the management of a variety of acute drug poisonings. However, SBT effects on serum potassium concentrations may lead to delayed QTc prolongation (DQTP), and subsequent risk of adverse cardiovascular events (ACVE), including death. Emergency department (ED)-based studies evaluating associations between SBT and ACVE are limited; thus, we aimed to investigate the association between antidotal SBT, ECG changes, and ACVE.

methodsThis was a secondary data analysis of a consecutive cohort of ED patients with acute drug overdose over 3 years. Demographic and clinical data as well as SBT bolus dosage and infusion duration were collected, and outcomes were compared with an unmatched consecutive cohort of patients with potential indications for SBT but who did not receive SBT. The primary outcome was the occurrence of ACVE, and secondary outcomes were delayed QTc (Bazett) prolongation (DQTP), and death. Propensity score and multivariable adjusted analyses were conducted to evaluate associations between adverse outcomes and SBT administration. Planned subgroup analysis was performed for salicylates, wide QRS (> 100 ms), and acidosis (pH < 7.2).

resultsOut of 2365 patients screened, 369 patients had potential indications for SBT, of whom 31 (8.4%) actually received SBT. In adjusted analyses, SBT was found to be a significant predictor of ACVE (aOR 9.35, CI 3.6-24.1), DQTP (aOR 126.7, CI 9.8-1646.2), and death (aOR 11.9, CI 2.4-58.9). Using a propensity score model, SBT administration was associated with ACVE (OR 5.07, CI 1.8-14.0). Associations between SBT and ACVE were maintained in subgroup analyses of specific indications for sodium channel blockade (OR 21.03, CI 7.16-61.77) and metabolic acidosis (OR: 6.42, 95% CI: 1.20, 34.19).

conclusionIn ED patients with acute drug overdose and potential indications for SBT, administration of SBT as part of routine clinical care was an independent, dose-dependent, predictor of ACVE, DQTP, and death. This study was not designed to determine whether the SBT or acute overdose itself was causative of ACVE; however, these data suggest that poisoned patients receiving antidotal SBT require close cardiovascular monitoring.

Indexed as

Action PotentialsAdolescentAdultAgedAged, 80 and overAntidotesDose-Response Relationship, DrugDrug OverdoseEmergency Service, HospitalFemaleHeart Conduction SystemHeart RateHumansLong QT SyndromeMaleMiddle AgedAntidotesSodium BicarbonateAdverse cardiovascular eventsOverdoseSodium bicarbonate

Identifiers

PMID32737857
PMCPMC7785762
OpenAlexW3046656599

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.