Red flags
- QRS >100 ms
- Seizures
- Hypotension
- Arrhythmia (VT, torsades)
First steps
- ABCDE + IV access + continuous ECG
- Activated charcoal if <1 h and airway protected
- IV fluids
Key investigations
- ECG (QRS width, R in aVR)
- ABG (metabolic acidosis)
- TCA levels rarely useful
Differentials
- Other Na-channel blocker overdose
- Hyperkalaemia
Initial management
- Sodium bicarbonate 1-2 mmol/kg IV bolus if QRS >100 or arrhythmia — target pH 7.5-7.55
- Benzo for seizures (avoid phenytoin — worsens conduction)
- Noradrenaline for hypotension
- AVOID class Ia/Ic antiarrhythmics
- Lipid emulsion for refractory arrest
Referral
- ICU + toxicology
AI clinical assessment
Enter patient details to generate evidence-based guidance.
This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
