Circulation
Commence continuous ECG monitoring and assess serial 12-lead ECGs to detect QRS widening.
For hypotension due to lamotrigine poisoning, first-line treatment is intravenous fluid resuscitation. If hypotension persists, start inotropic support.
If hypotension is refractory to intravenous fluids and inotropes, haemodialysis may be indicated. Discuss this with a clinical toxicologist. Use cardiac assist devices and extracorporeal circulatory support if available.
If there is evidence of QRS widening on ECG, manage urgently according to Treatment for QRS widening and sodium channel blockade: serum alkalinisation. Serum alkalinisation can be trialled for wide complex arrhythmias, but response is variable. Do not continue to give repeated intravenous bolus injections of sodium bicarbonate unless there is a clear response. Avoid inducing hypernatraemia and do not increase the serum pH above 7.55.
For cardiorespiratory arrest and life-threatening arrhythmias, follow advanced life support protocols1 and seek advice from a clinical toxicologist.