Related Experiment Video
Updated: Jan 11, 2026

Cell-based Calcium Assay for Medium to High Throughput Screening of TRP Channel Functions using FlexStation 3
Published on: August 17, 2011
Serum Alkalinization Affects Elimination of Flecainide in Chronic Toxicity: A Case Report
Rafael Lima1, Sydney Schacht2, Alan Hyslop3
1Division of Medical Toxicology, Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA, indiana.edu.
Background:
Supratherapeutic flecainide concentrations may result in wide complex cardiac dysrhythmias, which are normally treated with hypertonic sodium bicarbonate therapy. Previous cases have suggested that in acute toxicity, serum alkalinization may impair the elimination of flecainide.
Case Summary:
We present a single case of chronic flecainide toxicity. A 69-year-old patient began taking oral flecainide 1 month prior and developed recurrent wide complex tachycardia (WCT) that was refractory to treatment with sodium bicarbonate and repeated defibrillations. Further arrhythmias stopped after the resolution of alkalosis and treatment with lidocaine. Serum flecainide concentrations were notable for an apparent rise from initial levels following serum alkalinization.
Discussion:
Medication interactions and pharmacodynamic testing could not account for increasing serum flecainide concentrations following treatment. No evidence of supratherapeutic ingestion was identified. Tissue redistribution as a result of serum alkalinization likely contributed to impaired elimination in a patient with chronic flecainide toxicity.
Conclusions:
Serum alkalinization from sodium bicarbonate administration has implications in the length of stay and need for adjunctive therapies in the treatment of flecainide toxicity.
More Related Videos
Related Concept Videos
Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
Enhanced Elimination of Poison
Antidotes serve a crucial role in counteracting the effects of poison by inhibiting enzymes responsible for producing harmful drug metabolites. In some cases, these toxic metabolites can be neutralized by endogenous cosubstrates, which are maintained at specific concentrations to prevent interaction with cellular macromolecules and subsequent cell death.
Renal excretion is the...
Drug Accumulation During Multiple Dosing: Intermittent IV Infusions
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

