Differences

This shows you the differences between two versions of the page.

--- wiki:3.4.3.4_antiarrhythmics [2025/04/13 04:15] – ↷ Links adapted because of a move operation 18.235.158.19
+++ wiki:3.4.3.4_antiarrhythmics [2025/04/13 04:39] (current) – ↷ Links adapted because of a move operation 34.225.87.80
@@ Line 92: / Line 92: @@
 **Alkalinisation**
-Treatment with [[:concepts_systemic_alkalinisation|plasma alkalinisation]] to a pH of 7.5 using sodium bicarbonate (to alter both pH and sodium) or hyperventilation has been useful for arrhythmias induced by many sodium-channel blocking drugs. A number of case reports and animal studies suggest class IC antiarrhythmics also may respond. All other treatments are of questionable efficacy and safety and therefore controversial. Initial treatment is normally with sufficient IV NaHCO<sub>3</sub>  to produce a pH of 7.5 to 7.55. Following the rapid correction of pH to 7.5 by IV NaHCO<sub>3</sub>, the patient is usually maintained at this pH by mild hyperventilation. Alkalosis may cause a decrease in some free drug concentrations by increasing protein binding however this explanation is unconvincing for flecainide which has quite a low extent of protein binding. More likely, alkalosis affects the partitioning of antiarrhythmics between the cell membrane and the Na<sup>+</sup>   channel binding site and thus decreases Na+ channel blockade. Hypertonic saline alone also improves cardiac conduction.
+Treatment with [[:concept_serum_alkalinization|plasma alkalinisation]] to a pH of 7.5 using sodium bicarbonate (to alter both pH and sodium) or hyperventilation has been useful for arrhythmias induced by many sodium-channel blocking drugs. A number of case reports and animal studies suggest class IC antiarrhythmics also may respond. All other treatments are of questionable efficacy and safety and therefore controversial. Initial treatment is normally with sufficient IV NaHCO<sub>3</sub>  to produce a pH of 7.5 to 7.55. Following the rapid correction of pH to 7.5 by IV NaHCO<sub>3</sub>, the patient is usually maintained at this pH by mild hyperventilation. Alkalosis may cause a decrease in some free drug concentrations by increasing protein binding however this explanation is unconvincing for flecainide which has quite a low extent of protein binding. More likely, alkalosis affects the partitioning of antiarrhythmics between the cell membrane and the Na<sup>+</sup>   channel binding site and thus decreases Na+ channel blockade. Hypertonic saline alone also improves cardiac conduction.
 **Further drug treatment of arrhythmias**