Pediatric flecainide toxicity from a double dose

A 23-month-old boy was brought to the emergency department of an adult and pediatric tertiary care center 1 hour after an inadvertent “double dose” of 120 mg flecainide (9.2 mg/kg). His electrocardiogram revealed sinus rhythm with a terminal R wave in aVR greater than 7 mm, a bifascicular block, and...

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Bibliographic Details
Published in:The American journal of emergency medicine 2012-11, Vol.30 (9), p.2095.e1-2095.e2
Main Authors: Close, Benjamin R., BPharm, MBBS, Banks, Colin J., MBBS
Format: Article
Language:English
Subjects:
Anti-Arrhythmia Agents - therapeutic use
Anti-Arrhythmia Agents - toxicity
Arrhythmias, Cardiac - chemically induced
Arrhythmias, Cardiac - drug therapy
Asymptomatic
Cardiac arrhythmia
Drug overdose
Electrocardiography
Emergency
Emergency medical care
Emergency Service, Hospital
Flecainide - poisoning
Flecainide - therapeutic use
Flecainide - toxicity
Heart - drug effects
Heart - physiopathology
Hemodynamics
Humans
Infant
Male
Pediatrics
Prescription Drug Misuse
Sinuses
Sodium
Sodium Bicarbonate - therapeutic use
Toxicity
Vital signs
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Summary:A 23-month-old boy was brought to the emergency department of an adult and pediatric tertiary care center 1 hour after an inadvertent “double dose” of 120 mg flecainide (9.2 mg/kg). His electrocardiogram revealed sinus rhythm with a terminal R wave in aVR greater than 7 mm, a bifascicular block, and prolonged QRS and QTc intervals. A dramatic improvement in the bifascicular block and terminal R wave occurred after the administration of sodium bicarbonate. He was discharged after 36 hours with no complications. This case demonstrates that flecainide can cause significant cardiac conduction disturbances in doses much lower than previously described. All supratherapeutic ingestions should be assessed in hospital.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2012.01.005