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Effective use of magnesium for acquired torsade de pointes in a 4-month-old infant
1Department of Pharmacy Practice, University of Illinois, Chicago 60612, USA.
Insights
A 4-month-old infant developed torsade de pointes (TdP) from procainamide. Intravenous magnesium sulfate successfully treated the TdP, resolving the arrhythmia.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Background:
- Procainamide is used to treat supraventricular tachycardias in infants.
- Congenital long QT syndrome and drug-induced QT prolongation can predispose infants to arrhythmias.
Observation:
- A 4-month-old infant with atrial flutter received intravenous procainamide, converting to normal sinus rhythm.
- Upon transitioning to oral procainamide, the infant developed incessant torsade de pointes.
- The proarrhythmia resolved rapidly after withholding procainamide and administering intravenous magnesium sulfate.
Findings:
- This case highlights procainamide-induced torsade de pointes in an infant.
- Intravenous magnesium sulfate is an effective treatment for procainamide-induced TdP in neonates.
- Magnesium infusion was continued until procainamide and N-acetylprocainamide levels were undetectable.
Implications:
- Intravenous magnesium administration is recommended for newborns with acquired torsade de pointes.
- Dosing guidelines for magnesium in this context warrant further investigation.
- This case underscores the importance of monitoring for drug-induced arrhythmias in pediatric patients.
Abstract:
We report a 4-month-old infant with torsade de pointes secondary to procainamide treatment. The infant presented with atrial flutter and converted to normal sinus rhythm with intravenous procainamide. Oral procainamide therapy was initiated as the infusion was tapered, and the patient subsequently developed incessant torsade de pointes. Once the proarrhythmia was recognized, procainamide was withheld, and intravenous magnesium was administered. The torsade de pointes resolved after one bolus of magnesium sulfate. An infusion regimen of magnesium was given until the procainamide and N-acetylprocainamide concentrations became undetectable. Intravenous magnesium should be administered to newborns with acquired torsade de pointes; dosing guidelines for its use are suggested.