USMLE Step 2 Antibiotics and Treatments Practice Exam

In the context of managing a tricyclic antidepressant (TCA) overdose, administering sodium bicarbonate is the intervention that should be avoided if the patient has low potassium levels. TCA overdoses can lead to metabolic acidosis and significant cardiovascular complications, where sodium bicarbonate is often used as an alkalinizing agent to counteract the toxic effects of the overdose, particularly on the heart.

However, sodium bicarbonate can lead to a further decrease in serum potassium levels by promoting intracellular shifts of potassium. In patients already presenting with hypokalemia (low potassium levels), administering sodium bicarbonate could exacerbate this condition and increase the risk of cardiac toxicity due to the already compromised heart function associated with TCA overdose.

Maintaining normal potassium levels is critical during the management of TCA toxicity because potassium plays a vital role in cardiac conduction and overall myocardial function. Thus, if a patient's potassium levels are low, prudent management would involve addressing the hypokalemia before considering sodium bicarbonate administration to avoid further complications.

Other interventions, such as starting IV fluids, insulin therapy, or monitoring vital signs, are generally supportive measures and do not carry the same risk of exacerbating hypokalemia as sodium bicarbonate does in this scenario.

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