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[Hemoperfusion in flecainide poisoning].

R Wurzberger, E Witter, H Avenhaus

    Klinische Wochenschrift
    |May 2, 1986
    PubMed
    Summary
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    Flecainide treatment for ventricular extrasystoles led to pacemaker malfunction and kidney failure in a 79-year-old patient. Hemoperfusion proved ineffective for rapidly lowering high flecainide plasma levels during intoxication.

    Area of Science:

    • Clinical Pharmacology
    • Cardiology
    • Nephrology

    Background:

    • A 79-year-old patient with a history of myocardial infarctions and ventricular extrasystoles (Lown IV b) was prescribed flecainide.
    • The patient had a pacemaker and normal renal function upon initiation of flecainide therapy.

    Observation:

    • After 9 days of flecainide treatment (200 mg daily), the patient experienced temporary electromechanic pacemaker decoupling, reversible asystole, and progressive kidney failure.
    • Flecainide plasma levels reached 1460 ng/ml during this period.

    Findings:

    • Hemoperfusion with activated charcoal for 3 hours removed only 35 mg of flecainide, despite high flecainide clearance (164-180 ml/min).
    • The procedure failed to significantly reduce the patient's elevated flecainide plasma levels.

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    Implications:

    • This case highlights the potential for flecainide intoxication to cause severe cardiovascular and renal complications.
    • Hemoperfusion is demonstrated as an insufficient method for rapid reduction of flecainide levels in intoxication scenarios.
    • Close monitoring of flecainide plasma concentrations and renal function is crucial during therapy, especially in patients with cardiac devices.