What is the Sodium Bicarbonate dose for adult stable really wide complex tachycardia?

• A. 25 mEq
• B. 50 mEq
• C. 75 mEq
• D. 100 mEq

Answer: (B)

In really wide complex tachycardia, especially when sodium channel blocker toxicity (like TCA overdose) is suspected, sodium bicarbonate is given to counteract the blockade and improve conduction. The key idea is to alkalinize the serum and raise extracellular sodium to help the heart muscle regain faster, more normal conduction, which narrows the QRS and stabilizes the rhythm.

The standard, practical bolus dose for an adult is 50 mEq given IV, usually over 1–2 minutes. This amount is a common fixed dose that works well across many patients and is repeated if the QRS remains wide or the patient remains unstable, aiming for a serum pH around 7.50–7.55. Smaller doses, like 25 mEq, are often not enough to overcome the sodium channel blockade, while larger amounts (75–100 mEq) increase the risk of metabolic alkalosis and other complications without providing extra reliable benefit in this scenario. So 50 mEq per bolus hits the balance of effectiveness and safety in this setting.