Flecainide toxicity in renal tubular acidosis type IV treated with extracorporeal membrane oxygenation

Bhimani, Salima; Rao, Sruti; Nadorlik, Holly; Saarel, Elizabeth V.; Aziz, Peter F.

doi:10.1016/j.hrcr.2020.02.001

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Previous reports have indicated favorable outcomes when using ECMO for severe toxicological exposures, particularly with pharmaceuticals such as antiarrhythmic drugs and other cardiovascular medications, diphenhydramine, TCAs, and cocaine. [17][18][19][20][21]…”

Section: Discussionmentioning

confidence: 99%

Diphenhydramine overdose detected early by integration of toxidrome and electrocardiography and treated with venoarterial extracorporeal membrane oxygenation: a case report

Matsuoka,

Arai,

Ihara

et al. 2023

J Int Med Res

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Drug overdose can lead to a range of symptoms, including potentially life-threatening cardiac arrhythmias. However, identifying the specific causative drug upon admission can be challenging in many cases. The toxidrome approach is a method that utilizes toxidromes, which are collections of findings obtained from physical examination and ancillary tests, that may be caused by a specific toxin. In this particular case, a man presented with an unknown drug overdose that caused symptoms indicative of anticholinergic effects and abnormal electrocardiogram (ECG) findings. The ECG revealed an R wave in lead aVR, S waves in leads I and aVL, and wide QRS tachycardia with a Brugada pattern. Shortly after arrival, the patient developed cardiac arrest due to a lethal arrhythmia. Prompt initiation of venoarterial extracorporeal cardiopulmonary membrane oxygenation (VA-ECMO) was performed. Fortunately, the patient achieved full neurological recovery, and the overdosed drug was identified as diphenhydramine. When diagnosing and treating drug overdose caused by an unidentified substance, diphenhydramine toxicity should be considered when an anticholinergic toxidrome is present and a Brugada pattern is observed on the ECG. VA-ECMO demonstrates potential as a viable treatment option when initial interventions prove ineffective.

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Section: Discussionmentioning

confidence: 99%

Diphenhydramine overdose detected early by integration of toxidrome and electrocardiography and treated with venoarterial extracorporeal membrane oxygenation: a case report

Matsuoka,

Arai,

Ihara

et al. 2023

J Int Med Res

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“…6 A 4-month-old infant with renal tubular acidosis type IV was treated with extracorporeal membrane oxygenation due to flecainide toxicity. 7 The patient acutely decompensated with hypotension as the rhythm degenerated into sustained wide complex tachycardia at rates of 225-240 beats/min. Sinus rhythm was restored after 36 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Alkalisation with sodium bicarbonate to achieve a pH goal of 7.5-7.55 is thought to decrease the ionised form of flecainide that usually binds to sodium channels. 7 Lipid infusion removes the lipid-soluble drugs from serum. 6 Because there is no established treatment protocol on how to infuse lipids in these cases, I chose to give the treatment for 3 days.…”

Section: Discussionmentioning

confidence: 99%

Management of life-threatening flecainide overdose: a case report of an infant

Tunçer

2021

Cardiol Young

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Case Files from the University of California San Diego Medical Toxicology Fellowship: Neonatal Flecainide Toxicity from an Accidental Dosing Error

Seltzer,

Schneir

2024

J. Med. Toxicol.

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Flecainide toxicity in renal tubular acidosis type IV treated with extracorporeal membrane oxygenation

Cited by 5 publications

References 11 publications

Diphenhydramine overdose detected early by integration of toxidrome and electrocardiography and treated with venoarterial extracorporeal membrane oxygenation: a case report

Diphenhydramine overdose detected early by integration of toxidrome and electrocardiography and treated with venoarterial extracorporeal membrane oxygenation: a case report

Management of life-threatening flecainide overdose: a case report of an infant

Case Files from the University of California San Diego Medical Toxicology Fellowship: Neonatal Flecainide Toxicity from an Accidental Dosing Error

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