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Postmortem increase of flecainide level in cardiac blood
Kei Yoshitome1, Satoru Miyaishi, Yuji Yamamoto
1Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. kei_y@md.okayama-u.ac.jp
This case study highlights fatal congestive heart failure linked to flecainide. Postmortem blood tests revealed a significant increase in flecainide levels due to redistribution after death.
Area of Science:
- Pharmacology
- Toxicology
- Cardiology
Background:
- Flecainide is an antiarrhythmic drug used to treat heart rhythm disorders.
- Congestive heart failure is a serious condition where the heart cannot pump blood effectively.
Observation:
- A patient receiving flecainide experienced fatal congestive heart failure.
- Antemortem flecainide plasma concentration was 2.5 mg/L.
- Postmortem cardiac blood showed significantly elevated flecainide levels (13.8-44.2 mg/L) and decreased pH (5.5).
Findings:
- An extreme postmortem increase in flecainide concentration was observed in cardiac blood.
- This increase was attributed to postmortem redistribution, occurring 18 hours after the last flecainide intake.
- The observed flecainide levels were substantially higher than antemortem measurements.
Implications:
- Postmortem redistribution of flecainide can lead to misleadingly high concentrations in blood.
- Accurate interpretation of postmortem toxicology is crucial in cases of suspected drug-related fatalities.
- Understanding flecainide's pharmacokinetic behavior postmortem is essential for forensic and clinical toxicology.
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