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Pathophys and Cause ⬇

Pathophys:Anticholinergic effects and fast channel blockade

Lab and Xray ⬆ ⬇

Lab:Monitoring EKG × 24 h adequate (Jama 1985;254:1772); drug levels not predictive of cmplc (Nejm 1985;313:474); seizures predicted (in 34%) by QRS >0.10 sec and Vtach/fib predicted (in 50%) by QRS >0.16 sec (Nejm 1985;313:474) or RaVR >3 mm has best predictive (43%) value for seizure or ventricular arrhythmias (Ann Emerg Med 1995;26:195)

Treatment ⬆

Rx:Supportive usually is all need; rx arrhythmias or wide QRS w bicarb 1-2 mM/kg iv if heart block or ventricular arrhythmia (B. Higgins, ME Med Ctr 10/92)