Flecainide Toxicity Secondary to Accidental Overdose: A Pediatric Case Report of Two Brothers

Flecainide is a class 1C antiarrhythmic with a narrow therapeutic window and thereby a high-risk medication for causing acute toxicity. Dysrhythmias secondary to flecainide ingestion are often refractory to antiarrhythmics and cardioversion, and patients commonly require extracorporeal support. We review the successful resuscitation of two brothers aged 2 and 4 who presented two years apart with unstable wide-complex tachyarrhythmia suspicious for severe flecainide toxicity. Each patient received sodium bicarbonate and 20% intravenous lipid emulsion with a full recovery. While extracorporeal support is often required following flecainide ingestion, we present two cases where it was avoided due to aggressive multimodal management with sodium bicarbonate, electrolyte repletion, and 20% intravenous lipid emulsion. In addition, avoidance of agitation-induced tachycardia may be beneficial.

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Intravenous Lipid Emulsion-Associated Catatonia, Thrombocytopenia, and Leukopenia: A Case Report and the Role of NMDA Receptor

Psychosomatics ◽

10.1016/j.psym.2011.12.001 ◽

2012 ◽

Vol 53 (2) ◽

pp. 193-195 ◽

Cited By ~ 2

Author(s):

Chih-Sung Liang ◽

Fei-Wen Yang ◽

Pei-Shen Ho

Keyword(s):

Case Report ◽

Nmda Receptor ◽

Lipid Emulsion ◽

Intravenous Lipid Emulsion

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Respiratory depression following an accidental overdose of a CBD-labeled product: A pediatric case report

Journal of the American Pharmacists Association ◽

10.1016/j.japh.2019.09.023 ◽

2020 ◽

Vol 60 (1) ◽

pp. 248-252 ◽

Cited By ~ 1

Author(s):

Jim Herbst ◽

Gyen Musgrave

Keyword(s):

Case Report ◽

Respiratory Depression ◽

Pediatric Case ◽

Accidental Overdose

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Nearly Fatal Hydroxychloroquine Overdose Successfully Treated with Midazolam, Propofol, Sodium Bicarbonate, Norepinephrine, and Intravenous Lipid Emulsion

Case Reports in Emergency Medicine ◽

10.1155/2021/8876256 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Goswin Onsia ◽

Sarah Bots

Keyword(s):

Sodium Bicarbonate ◽

Lipid Emulsion ◽

Life Support ◽

Extracorporeal Life Support ◽

Scientific Evidence ◽

Treatment Options ◽

Cardiac Monitoring ◽

High Dose ◽

Epinephrine Infusion ◽

Intravenous Lipid Emulsion

Background. In the context of the current COVID-19 pandemic, there has been renewed interest in the drug hydroxychloroquine. However, clinicians should be aware of the dangers of hydroxychloroquine intoxication, an insufficiently studied condition. Case Report. We present a case of autointoxication with 20 g hydroxychloroquine in a 35-year-old woman. Cardiac monitoring showed ventricular arrhythmias for which high-dose midazolam and propofol were initiated, resulting in a brief normalization of the cardiac rhythm. Because of the reoccurrence of these arrhythmias, intravenous lipid emulsion was administered with fast cardiac stabilization. Treatment with continuous norepinephrine, potassium chloride/phosphate, and sodium bicarbonate was initiated. On day 6, she was extubated and after 11 days, she was discharged from the hospital without complications. Conclusion. Since high-quality scientific evidence is lacking, treatment options are based on experience in chloroquine toxicity. Activated charcoal is advised if the patient presents early. Sedation with diazepam, early ventilation, and continuous epinephrine infusion are considered effective in treating severe intoxication. Caution is advised when substituting potassium. Despite the lack of formal evidence, sodium bicarbonate appears to be useful and safe in case of QRS widening. Intravenous lipid emulsion, with or without hemodialysis, remains controversial but appears to be safe. As a last resort, extracorporeal life support might be considered in case of persisting hemodynamic instability.

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