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Pediatric flecainide toxicity from a double dose.

Benjamin R Close¹, Colin J Banks

¹Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia. benjamin_close@health.qld.gov.au

The American Journal of Emergency Medicine

|March 6, 2012

Summary

This summary is machine-generated.

A child experienced severe cardiac conduction issues after a flecainide overdose. Sodium bicarbonate effectively treated these flecainide toxicity symptoms, highlighting the need for prompt hospital assessment of supratherapeutic ingestions.

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Area of Science:

Cardiology
Clinical Toxicology
Pediatric Emergency Medicine

Background:

Flecainide is a Class Ic antiarrhythmic agent used to treat various cardiac arrhythmias.
Supratherapeutic levels of flecainide can lead to significant cardiotoxicity, including conduction abnormalities.
The management of flecainide toxicity, particularly in pediatric populations, requires careful consideration.

Observation:

A 23-month-old boy presented with a history of accidental flecainide overdose (120 mg, 9.2 mg/kg).
Electrocardiogram (ECG) findings included sinus rhythm with a prominent terminal R wave in aVR (>7 mm), bifascicular block, and prolonged QRS and QTc intervals.
The patient received sodium bicarbonate for treatment.

Findings:

Administration of sodium bicarbonate resulted in marked improvement of the bifascicular block and the terminal R wave in aVR.
The child experienced no complications and was discharged after 36 hours of observation.
This case suggests flecainide can induce severe cardiac conduction disturbances at lower doses than previously recognized.

Implications:

Flecainide-induced cardiotoxicity can occur at doses lower than anticipated, necessitating vigilant monitoring.
Prompt recognition and management with sodium bicarbonate are crucial for reversing flecainide toxicity.
All instances of supratherapeutic flecainide ingestion, especially in children, warrant immediate hospital evaluation and management.