Sodium bicarbonate to the ROSCue: a case report on how sodium bicarbonate successfully resuscitated a patient in cardiac arrest from suspected quetiapine and trazodone overdose.

Madhumita Kolluri, Jennifer Callaghan, Joel Wilken, Jason Gluck

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Article in European heart journal. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 authors.

Madhumita KolluriDepartment of Internal Medicine, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030-1235, USA.ORCID https://orcid.org/0000-0003-4504-8297

Jennifer CallaghanDepartment of Cardiology, Hartford Healthcare, 85 Seymour Street Suite 603, Hartford, CT 06106, USA.

Joel WilkenDepartment of Internal Medicine, Hartford Healthcare, 80 Seymour Street, Hartford, CT 06102, USA.

Jason GluckDepartment of Cardiology, Hartford Healthcare, 85 Seymour Street Suite 603, Hartford, CT 06106, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Per ACLS algorithms (Class III, LOE B), sodium bicarbonate (SB) use is indicated for cardiac arrest with underlying hyperkalaemia, tricyclic antidepressant (TCA) overdose, or pre-existing severe metabolic acidosis, with routine use of SB being discouraged due to concerns raised in animal studies. However, SB is a potent antidote for sodium channel blockade (SCB) in drug toxicities beyond TCA toxicity and should be considered more broadly. Case summary: We present a 50-year-old man who suffered an out-of-hospital cardiac arrest with a wide-complex bradycardia (QRS 184 ms) due to suspected quetiapine (atypical antipsychotic) and trazodone (serotonin modulator) overdose. After SB administration, the QRS narrowed to 142 ms and ROSC was immediately achieved. Discussion: Trazodone, a popular sleep medication, rarely leads to cardiac arrhythmias, and secondary cardiac arrest is exceptionally rare. Nonetheless, both trazodone and quetiapine can cause SCB in toxic doses. Intravenous SB can rapidly overcome medication-induced SCB and narrow a prolonged QRS and/or QTc interval. Although the role of SB in cardiac arrest remains limited, SB in SCB toxicity in TCA overdose

Indexed as

Cardiac arrestCase reportQuetiapineSodium bicarbonateSodium channel blockadeTrazodone

Identifiers

PMID41281247

DOI10.1093/ehjcr/ytaf546

PMCPMC12639539

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