First Case of Acute Poisoning with Amiodarone and Flecainide in Attempted Suicide Successfully Managed with Lipid Emulsion Therapy in the Emergency Department: Case Report and Literature Review

Abstract

Acute antiarrhythmics poisoning represents a challenge in the Emergency Department (ED). These patients often develop malignant arrhythmias in need of exceptional therapeutic measures in the ICU. We report a 47-year-old patient admitted to the ED 5 h after the ingestion of a large dose of amiodarone and flecainide in a suicide attempt. During their ED stay, the patient developed signs of cardiotoxicity evidenced by electrocardiogram and ventricular arrhythmias. The toxicological results showed a level of 4.8 mg/L amiodarone and 2.98 mg/L flecainide. He was successfully treated in the ED using a large dose of sodium bicarbonate and lipid emulsion therapy. After hospital admission, he remained stable, with no need for exceptional therapeutic measures such as mechanical circulatory support, cardiac pacing or ECMO. We emphasize the importance of an early start of pharmacological therapies in the ED, which might improve the outcome in antiarrhythmic acute poisoning.

Usefulness of lipid emulsion for the management of cardiac toxicity in acute flecainide overdose

“…El tratamiento se basa en la descontaminación digestiva, administración de bicarbonato de sodio a altas dosis, fármacos inotrópicos, marcapasos transitorio y medidas de soporte. Las arritmias a menudo son refractarias a la cardioversión y la hemofiltración no es eficaz 4,5 . Aun no existiendo ensayos controlados aleatorios que prueben la eficacia de la ELI, debe considerarse como un antí-doto de rescate en la cardiotoxicidad por fármacos liposolubles, cuando las medidas habituales de reanimación cardiopulmonar sean ineficaces.…”