Keywords
Flecainide
Cardiogenic shock
Symptomatic treatment
Categories
How to Cite
Abstract
Flecainide acetate is an antiarrhythmic drug used in the treatment of supraventricular arrhythmias. Flecainide causes very rare but often serious intoxications. These intoxications happen either due to a non-accidental overdose or because of a narrow therapeutic index in a patient who suffers from cardiomyopathy or has electrolyte abnormalities. We report an original case of a patient who had taken a high dose of flecainide with the aim of suicide. The patient suffered a cardiogenic shock with complications of lactic metabolic acidosis. Fast diagnosis is essential to reduce the high morbidity and mortality of this intoxication. The treatment plan is symptomatic. It aims at eliminating the poison and compensating cardiac function by treating the shock and the electrolyte imbalances. This allowed us to swiftly regain normal electrical and mechanical cardiac function in our patient. 3 weeks after the psychiatric consultation no sequelae were found. This case highlights that thorough history is essential to determine the diagnosis of a drug intoxication since the range of used products is wide. On the other hand, in case of any intoxication, while we apply a specific treatment, a well-managed, systematic, symptomatic treatment is essential to reduce morbidity and mortality.
References
Roden DM, Woosley RL. Drug therapy. Flecainide. N Engl J Med. 1986 Jul 3; 315(1):36. https://doi.org/10.1056/nejm198607033150106
Jaeger A, Sauder P. Les intoxications par les antiarythmiques de la classe I. Les Intoxications aiguës, Arnette, Paris. 1993:359-73.
Hazouard E, Legras A, Dequin P, Perrotin D. Intoxications graves après ingestion modérée de flécaïnide deux observations. Reanimation Urgences. 1998;7(5):599602. https://doi.org/10.1016/S1164-6756(99)80011-5
André P, Berginiat N, Triaureau G, Lalande G. À propos d'un cas d'intoxication par la Flécaïne< sup>®. Urgences Medicales. 1997;16(5):205-7.
Son C-W, Lee S-H, Shin D-G, Hong G-R, Park J-S. Acquired long QT syndrome and ventricular tachycardia in a patient on flecainide therapy. J Cardiol Cases.2011 Mar 29; 3(3):e137-e42. https://doi.org/10.1016/j.jccase.2011.02.006
CA G. Flecainide. xPharm: The Comprehensive Pharmacology Reference2007. p. 1-7.
Soni S, Gandhi S. Flecainide overdose causing a Brugada-type pattern on electrocardiogram in a previously well patient. Am J Emerg Med. 2009 Mar; 27(3):375. e1-375.e3. https://doi.org/10.1016/j.ajem.2008.07.038
Timperley J, Mitchell AR, Brown PD, West NE. Flecainide overdose–support using an intra-aortic balloon pump. BMC Emerg Med. 2005 Dec 12; 5(1):10. https://doi.org/10.1186/1471-227x-5-10
Cabrera Ortega M, Gell Aboy J, Díaz Berto E, Monagas Docasal V, editors. Intoxicación aguda por flecainida. Ann Pediatr (Barc). 2011 Jan; 74(1):56-8. https://doi.org/10.1016/j.anpedi.2010.06.013
Vivien B, Deye N, Mégarbane B, Marx J-S, Leprince P, Bonnet N, et al. Extracorporeal life support in a case of fatal flecainide and betaxolol poisoning allowing successful cardiac allograft. Ann Emerg Med. 2010 Oct; 56(4):409-12. https://doi.org/10.1016/j.annemergmed.2010.01.02
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2014 Abdelilah Ghannam et al.
