Efficacy and mechanism of action of sodium bicarbonate in the treatment of desipramine toxicity in rats

P. Pentel, N. Benowitz

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115 Scopus citations


Alkalinization of the blood by administration of sodium bicarbonate or hyperventilation is widely recommended for treatment of cardiac toxicity due to tricyclic antidepressant overdose, yet its efficacy and mechanism of action are poorly defined. We studied the effects and possible mechanism of action of 1 M NaHCO3 of desipramine (DMI) toxicity in anesthetized, paralyzed rats. Administration of DMI (45 mg/kg i.p.) produced a mean increase in QRS duration of 142% and a mean decrease in mean arterial pressure of 46%. Treatments were administered i.v. 35 min after DMI and their effects were assessed 10 min later. NaHCO3 (1 M) at doses of 3 and 6 mEq/kg decreased mean QRS duration 15 ± 5 and 24 ± 6%, respectively (mean ± S.D.) and was superior to no treatment (P < .01). NaCl (1 M) was as effective as NaHCO3 in decreasing QRS duration, as was 1 M NaHCO3 supplemented with 48 mM KCl. Respiratory alkalosis and 10% mannitol did not decrease QRS duration. NaHCO3 NaCl and NaHCO3/KCl all produced comparable increases in mean arterial blood pressure. Respiratory alkalosis and mannitol did not increase mean arterial pressure, but did prevent the decline seen in control animals. Acidosis produced by ventilation with 10% CO2 exacerbated QRS prolongation due to DMI. In acidotic animals, NaHCO3 and NaCl were equally effective in reversing QRS prolongation and hypotension. Correction of respiratory acidosis by discontinuation of inhaled CO2 did not improve QRS duration or mean arterial pressure. The beneficial effects of treatments on QRS prolongation correlated with increases in plasma sodium concentration but not with changes in plasma potassium or DMI concentrations, arterial pH or the degree of intravascular volume expansion. We conclude that (1) 1 M NaHCO3 can partially reverse the cardiovascular toxicity of DMI in both normal pH and acidotic animals, (2) the beneficial effects of NaHCO3 on QRS prolongation may be due to increasing the plasma sodium concentration, (3) acidosis exacerbates DMI toxicity but correction of acidosis or increasing blood pH above normal were not effective therapies and (4) the beneficial effect of NaHCO3 on blood pressure may be due to factors in addition to increasing plasma sodium concentration, such as intravascular volume expansion.

Original languageEnglish (US)
Pages (from-to)12-19
Number of pages8
JournalJournal of Pharmacology and Experimental Therapeutics
Issue number1
StatePublished - 1984
Externally publishedYes


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