Flecainide Toxicity Secondary to Accidental Overdose: A Pediatric Case Report of Two Brothers. (15th May 2021)

• Record Type: Journal Article
• Authors: Gardner Yelton, Sarah E.; Leonard, James B.; de la Uz, Caridad M.; Wadia, Rajeev S.; Barnes, Sean S.
• Other Names: Metsvaht Tuuli Academic Editor.
• Is Part Of: Case reports in critical care. Volume 2021(2021)
• Publication Date: 2021-05-15
• Subjects: Critical care medicine -- Periodicals; Emergency medicine -- Periodicals; Medical emergencies -- Periodicals; 616.02805
• DOI: 10.1155/2021/6633859
• Languages: English
• ISSNs: 2090-6420

Abstract

Abstract : Flecainide is a class 1C antiarrhythmic with a narrow therapeutic window and thereby a high-risk medication for causing acute toxicity. Dysrhythmias secondary to flecainide ingestion are often refractory to antiarrhythmics and cardioversion, and patients commonly require extracorporeal support. We review the successful resuscitation of two brothers aged 2 and 4 who presented two years apart with unstable wide-complex tachyarrhythmia suspicious for severe flecainide toxicity. Each patient received sodium bicarbonate and 20% intravenous lipid emulsion with a full recovery. While extracorporeal support is often required following flecainide ingestion, we present two cases where it was avoided due to aggressive multimodal management with sodium bicarbonate, electrolyte repletion, and 20% intravenous lipid emulsion. In addition, avoidance of agitation-induced tachycardia may be beneficial.