IngentaConnect Hypertonic Sodium Bicarbonate for Taxus media-induced Cardiac Tox...

Authors: Graeme, Kimberlie A.; Ruha, Anne-Michelle; Tanen, David A.¹; Curry, Steven C.; Miller, Mary Beth²; Gerkin, Richard; Reagan, Christine G.³; Brandon, Tedd A.⁴

Source: Academic Emergency Medicine, Volume 9, Number 3, March 2002 , pp. 179-185(7)

Publisher: Blackwell Publishing

Abstract:

Objective: To determine whether intravenous (IV) hypertonic sodium bicarbonate is effective in the reversal of QRS widening associated with severe Taxus intoxication. Methods: Seventeen anesthetized and instrumented swine were poisoned with an IV extract of Taxus media until doubling of the QRS interval on electrocardiography was achieved. After poisoning (time zero), the animals received either 4 mL/kg IV 8.4% sodium bicarbonate (experimental group; 6 animals), a similar volume of 0.7% NaCl in 10% mannitol (mannitol group; 6 animals), or nothing (control group; 5 animals). The main outcome parameter was QRS duration. Secondary outcome parameters were mean arterial pressure (MAP), heart rate (HR), and cardiac index (CI = cardiac output/kg). Additionally, arterial pH, partial pressure of carbon dioxide (pCO₂), and plasma-ionized calcium, sodium, and potassium were monitored. Results: Taxus toxicity, defined as a 100% increase in QRS duration, was produced in all animals. The animals were similar in regard to baseline and time 0 physiologic parameters as well as amount of Taxus media extract administered. From times 5 through 30 minutes, following assigned treatment, significant increases in QRS duration were detected in the experimental and mannitol groups compared with the control group. A significant lowering of MAP was found in the experimental group compared with the control group. No significant difference between groups was noted in HR or CI. The swine treated with hypertonic sodium bicarbonate had a statistically significant increase in pH, plasma sodium concentration, and base excess compared with the other groups. Conclusions: Hypertonic sodium bicarbonate was ineffective in reversing the widening of QRS interval associated with Taxus poisoning in this swine model.

Keywords: Taxus; yew; sodium channel blockade; sodium bicarbonate; antidote

Document Type: Research article

DOI: 10.1197/aemj.9.3.179

Affiliations: 1: Department of Emergency Medicine, Naval Medical Center, San Diego, CA 2: Department of Emergency Medicine, Michigan State University, Lansing, MI 3: Banner Research Institute, Phoenix, AZ 4: Arizona State University Animal Care Center, Tempe, AZ.

The full text electronic article is available for purchase. You will be able to download the full text electronic article after payment.

$50.16 plus tax Refund Policy

Hypertonic Sodium Bicarbonate for Taxus media-induced Cardiac Toxicity in Swine