Cardiotoxic and psychotropic medication poisoning

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Target exams

Red flags

• A widened QRS in the poisoned child is sodium-channel blockade, most often from a tricyclic antidepressant: give intravenous sodium bicarbonate 1 to 2 mL per kg of 8.4 per cent and repeat to narrow the QRS and raise the pH to 7.45 to 7.55
• Never give a class Ia or Ic antiarrhythmic (quinidine, procainamide, flecainide) or amiodarone for a tricyclic-induced ventricular arrhythmia: each worsens sodium-channel blockade
• Severe beta-blocker or calcium channel blocker overdose needs high-dose insulin euglycaemic therapy, not escalating inotropes alone: insulin 1 unit per kg bolus then 0.5 to 1 unit per kg per hour with glucose, monitoring potassium and glucose hourly
• Hyperglycaemia in a bradycardic, hypotensive poisoned child points to a calcium channel blocker, not a beta-blocker: a bedside discriminator that changes the calcium and insulin plan
• A sustained-release calcium channel blocker can deteriorate late and outlast the initial resuscitation: observe for at least 12 to 24 hours and escalate early
• Antipsychotic overdose prolongs the QT and risks torsades de pointes: give intravenous magnesium, correct potassium and magnesium, and avoid every other QT-prolonging drug
• Any child with cardiotoxic shock, a ventricular arrhythmia or intensive-care needs beyond local support: call senior, intensive care or retrieval, and the Poisons Information Centre, now

Life stages

Care settings

Clinical exam formats

Board mappings

• Acute Care
• Current 2026 PREP curriculum — Learning Objective 2.4.4: Assess and manage infants, children and young people with potential cardiac, respiratory or neurological emergencies or acute poisonings
• Current 2026 PREP curriculum — Learning Objective 2.2.3: Perform acute resuscitation and advanced life support
• Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
• Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Acute care and procedures
• Renewed curriculum for first-year trainees from 2027 — Learning goal 17: Acute care
• Clinical Applications
• Medical Sciences
• Long Cases
• Short Cases
• 4. Professional skills and knowledge: Patient management
• 7. Patient safety, including safe prescribing
• General Paediatrics: Resuscitates, stabilises and treats extremely unwell babies, children and young people, liaising with specialist teams, as necessary
• General Paediatrics: Assumes the role of Acute Paediatric Team Leader
• Applied Knowledge in Practice (AKP)
• Theory and Science (TAS)
• Clinical
• History
• Communication
• Video
• General Pediatrics Content Outline — Domain 7: Emergency and Critical Care
• General Pediatrics Content Outline — Universal Task 4: Management and Treatment
• General Pediatrics EPA 7: Recognizing a Severely Ill Patient, Providing Initial Management, and Mobilizing Resources Needed for Continued Care
• Patient Care 5: Patient Management
• Patient Care 4: Clinical Reasoning
• Systems-Based Practice 1: Patient Safety
• Medical Expert
• Pediatrics: Core EPA #2 — Resuscitating and stabilizing critically ill patients
• Pediatrics: Foundations EPA #1 — Recognizing deteriorating and/or critically ill patients and initiating stabilization and management