Management of Tachycardia and Metabolic Acidosis

Initial Assessment and Management

• For a patient with tachycardia, fever, and metabolic acidosis, the American College of Cardiology recommends immediate evaluation to identify the underlying cause of tachycardia while addressing metabolic acidosis, with consideration for potential thromboembolic events due to OCP use 1, 2
• The American Heart Association suggests that first, determine hemodynamic stability - if unstable, immediate synchronized cardioversion is recommended 1, 2

Diagnostic Workup

• The American College of Cardiology recommends a complete 12-lead ECG analysis to confirm normal findings and rule out pre-excitation patterns 3, 4
• Blood tests, including complete blood count to assess for infection, and thyroid function tests to rule out hyperthyroidism as the cause of sinus tachycardia, are recommended by the American College of Cardiology 2, 5
• A chest X-ray to evaluate for pulmonary pathology is suggested by the American College of Cardiology 4
• An echocardiogram to exclude structural heart disease is recommended by the American College of Cardiology 3, 4

Management of Tachycardia

• The American Heart Association recommends trying vagal maneuvers as the first-line intervention for narrow complex tachycardia 1, 6
• If vagal maneuvers are unsuccessful, the American College of Cardiology suggests administering adenosine IV 6
• For persistent tachycardia, the American College of Cardiology recommends considering IV beta-blockers, diltiazem, or verapamil 6

Special Considerations with OCP History

• The American College of Cardiology recommends evaluating for possible thromboembolic complications, including D-dimer testing, CT pulmonary angiogram, and lower extremity ultrasound if clinically suspected 4, 5

Disposition and Follow-up

• Admission for further monitoring and management is warranted given the combination of tachycardia, fever, and metabolic acidosis, according to the American College of Cardiology 3, 7
• The American College of Cardiology suggests considering referral to a cardiac arrhythmia specialist if tachycardia persists despite initial management 3, 8