Hemodynamic and electrophysiological actions of cocaine

Effects of sodium bicarbonate as an antidote in dogs

K. J. Beckman, Robert Parker, R. J. Hariman, J. L. Gallastegui, J. I. Javaid, J. L. Bauman

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

Background. Cocaine abuse has been implicated as a cause of death due to sudden cardiac arrest. Methods and Results. We examined the hemodynamic and electrophysiological effects of cocaine administered as a series of 5-mg/kg i.v. boluses coupled with a continuous infusion in anesthetized dogs. Sodium bicarbonate (50 meq i.v.) was administered as a potential antidote in 11 of 15 dogs, and intravenous 5% dextrose was given in the remaining four. In a dose-dependent fashion, cocaine significantly decreased blood pressure, coronary blood flow, and cardiac output; increased PR, QRS, QT, and QTc intervals and sinus cycle length; and increased ventricular effective refractory period and dispersion of ventricular refractoriness. No afterdepolarizations were noted in the monophasic action potential recording. Nonsustained monomorphic ventricular tachycardia occurred spontaneously in two dogs, and sustained ventricular tachycardia could be induced by programmed stimulation at the end of the dosing protocol in five of 11 animals. Sodium bicarbonate promptly decreased cocaine-induced QRS prolongation to nearly that measured at baseline but had no effect on the other electrocardiographic or hemodynamic variables. In one dog, sodium bicarbonate administration was associated with reversion of ventricular tachycardia to sinus rhythm. Conclusions. We conclude that high-dose cocaine possesses negative inotropic and potent type I electrophysiological effects. Sodium bicarbonate selectively reversed cocaine-induced QRS prolongation and may be a useful treatment of ventricular arrhythmias associated with slowed ventricular conduction in the setting of cocaine overdose.

Original languageEnglish (US)
Pages (from-to)1799-1807
Number of pages9
JournalCirculation
Volume83
Issue number5
DOIs
StatePublished - Jan 1 1991

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Antidotes
Sodium Bicarbonate
Cocaine
Hemodynamics
Dogs
Ventricular Tachycardia
Cocaine-Related Disorders
Sudden Cardiac Death
Cardiac Output
Action Potentials
Cardiac Arrhythmias
Cause of Death
Blood Pressure
Glucose

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hemodynamic and electrophysiological actions of cocaine : Effects of sodium bicarbonate as an antidote in dogs. / Beckman, K. J.; Parker, Robert; Hariman, R. J.; Gallastegui, J. L.; Javaid, J. I.; Bauman, J. L.

In: Circulation, Vol. 83, No. 5, 01.01.1991, p. 1799-1807.

Research output: Contribution to journalArticle

Beckman, K. J. ; Parker, Robert ; Hariman, R. J. ; Gallastegui, J. L. ; Javaid, J. I. ; Bauman, J. L. / Hemodynamic and electrophysiological actions of cocaine : Effects of sodium bicarbonate as an antidote in dogs. In: Circulation. 1991 ; Vol. 83, No. 5. pp. 1799-1807.
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