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Acute propafenone toxicity after two exposures at standard dosing
Adam Yeung1, David Shanks, Harjinder Parwana
1Department of Internal Medicine, University of British Columbia, Vancouver, BC, Canada.
Propafenone toxicity, a rare event at therapeutic doses, can cause severe cardiovascular issues like hypotension and wide QRS complex. Sodium bicarbonate effectively reversed these toxic effects, normalizing heart function.
Area of Science:
- Cardiology
- Clinical Toxicology
Background:
- Propafenone is an antiarrhythmic drug used to treat atrial fibrillation.
- Propafenone toxicity can lead to significant cardiovascular compromise.
Observation:
- A 72-year-old woman presented with altered consciousness and hypotension shortly after initiating propafenone therapy.
- Electrocardiogram revealed atrial fibrillation with a wide QRS complex, indicative of drug toxicity.
Findings:
- The patient was diagnosed with acute propafenone toxicity, occurring despite therapeutic dosing.
- Administration of sodium bicarbonate rapidly corrected the QRS widening and stabilized the patient's hemodynamics.
Implications:
- This case highlights the potential for propafenone toxicity even at prescribed doses.
- Sodium bicarbonate is a crucial and effective antidote for managing propafenone-induced cardiotoxicity.
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