What should you consider using to treat a 26-year-old female who has ingested 150 amitriptyline tablets?

In cases of tricyclic antidepressant (TCA) overdose, such as with amitriptyline, sodium bicarbonate is often used because it can help to counteract the cardiotoxic effects associated with TCA toxicity. One of the significant concerns with TCA overdose is the risk of ventricular arrhythmias, which can arise from sodium channel blockade. Sodium bicarbonate works by raising the pH and can help stabilize cardiac function and reduce the risk of arrhythmias by promoting the dissociation of the drug from its receptor sites.

While activated charcoal can be used in cases of overdose to reduce the absorption of the drug in the gastrointestinal tract if administered within the appropriate time frame, it does not specifically address the toxicity issues presented by amitriptyline.

Flumazenil, a benzodiazepine antagonist, is not appropriate in this situation as it can precipitate seizures in patients with TCA overdose. Naloxone is effective for opioid overdoses but does not have a role in managing TCA toxicity.

Thus, in the management of a TCA overdose featuring amitriptyline, sodium bicarbonate serves as an effective intervention by particularly addressing the cardiac complications associated with the overdose.