Use of tromethamine in combination with sodium bicarbonate in the treatment of a wide complex dysrhythmia from presumed cocaine toxicity

This case illustrates the successful use of THAM in conjunction with sodium bicarbonate for the treatment of severe acidemia and refractory QRS complex widening in presumed cocaine toxicity. While sodium bicarbonate remains the mainstay of therapy for sodium channel blocker toxicity, THAM offers a potentially valuable adjunctive treatment, especially in the context of drug shortages.