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Related Experiment Videos

[Successful multiple resuscitation in flecainide poisoning].

K D Palitzsch1, H Bode, K Huck

  • 1II. Medizinische Klinik, Universität Heidelberg.

Deutsche Medizinische Wochenschrift (1946)
|January 10, 1992
PubMed
Summary

A woman survived a massive flecainide overdose, experiencing severe cardiorespiratory failure and ventricular fibrillation. High-dose lidocaine and defibrillation successfully treated the life-threatening cardiac arrhythmias.

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Area of Science:

  • Cardiology
  • Clinical Toxicology
  • Pharmacology

Background:

  • Flecainide is a Class Ic antiarrhythmic drug used to treat supraventricular and ventricular tachyarrhythmias.
  • Intentional drug overdose can lead to severe and life-threatening toxic effects.

Observation:

  • A 37-year-old woman ingested a large quantity of flecainide with alcohol, presenting with unconsciousness and cardiorespiratory failure.
  • ECG revealed idioventricular rhythm, QRS widening, and Q-T prolongation, indicative of flecainide toxicity.
  • The patient experienced multiple episodes of ventricular fibrillation and asystole, requiring repeated defibrillation and resuscitation.

Findings:

  • Peak plasma flecainide level was 6160 ng/ml, significantly exceeding the maximal therapeutic range.
  • Life-threatening tachyarrhythmias, including torsades de pointes, were managed with high-dose lidocaine (4 g daily) and defibrillation.

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  • The patient developed acute left ventricular failure, pulmonary edema, and pneumonia as late complications.

    • Implications:

    • This case highlights the potential for severe cardiotoxicity with massive flecainide overdose.
    • Aggressive management including high-dose lidocaine and advanced cardiac life support is crucial for survival.
    • Despite severe initial presentation, complete recovery without permanent sequelae is possible with intensive care.