Life-Threatening Flecainide Intoxication in a Young Child Secondary to Medication Error

Background Flecainide is a class IC antidysrhythmic primarily indicated for ventricular dysrhythmias and supraventricular tachycardia (SVT). Class IC antidysrhythmic overdoses has a reported mortality of 22% and death results from dysrhythmias and cardiovascular collapse. We report a near-fatal flecainide overdose in an 18-day old treated successfully with sodium bicarbonate. Case Report An 18-day old, 2 week premature, 4-kg boy developed persistently high heart rates (220-240 beats/min) and ECG changes consistent with supraventricular tachycardia. There was minimal response to vagal maneuvers, adenosine, and esmolol, and a transthoracic echocardiogram showed no underlying structural abnormality. He was then started on flecainide 4 mg PO Q8h. Following the fourth dose he developed lethargy, cold clammy skin and a heart rate of 40 beats/min with no palpable pulse. Patient was given 0.1 mg of atropine intravenously with an increase to 160 beats/min of the patient's heart rate. The child's cardiac monitor revealed a wide-complex tachycardia with left bundle branch morphology with associated pallor and poor cap refill. Sodium bicarbonate was administered intravenously due to suspected flecainide toxicity. Approximately five minutes after 10 mEq of 8.4% sodium bicarbonate intravenously twice his rhythm converted to a narrow-complex tachycardia. A serum flecainide concentration was 1360 mcg/L (therapeutic, 200-1000 mcg/L) drawn one hour prior to the cardiac arrest. It was later discovered that a 2-fold dosing error occurred: the patient received 8 mg Q8h instead of 4 mg Q8h for four doses. Conclusion Flecainide toxicity in children is rare, especially in neonates. It is important for clinicians to be able to identify and treat this uncommon poisoning.

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“…The patient became bradycardic followed by a wide-complex tachycardia that responded to intravenous sodium bicarbonate. [2]…”

Section: Discussionmentioning

confidence: 99%

A Case of Near-fatal Flecainide Overdose in a Neonate Successfully Treated with Sodium Bicarbonate

Jang

Hoffman

Nelson

2013

The Journal of Emergency Medicine

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“…Instead of withdrawing 5 mL of nadolol suspension (concentration not specified) and 1 mL of flecainide suspension (20 mg/mL), the nurse administered the opposite and the child received 5 mL of flecainide (100 mg). 2 In another case, a pharmacy dispensed a 5 mg/mL suspension for a 4-week-old child who was supposed to receive 3 mg/0.6 mL three times a day. Pharmacy staff erroneously transcribed the dosing instructions to take "3 mL" instead of 3 mg (0.6 mL), resulting in an overdose that led to wide complex tachycardia.…”

Section: Life-threatening Errors With Flecainide Suspension In Childrenmentioning

confidence: 99%

Patient-Controlled Analgesia Basal Infusion Overdose; Life-threatening Errors with Flecainide Suspension in Children; Medical Product Error-Prevention Efforts Need to be Shared and Harmonized Internationally

Cohen

Smetzer

2015

Hosp Pharm

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These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.

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“…It is unclear whether the previous 10 mg/mL suspension may also have been prepared incorrectly. Additional errors with compounded flecainide suspension have appeared in the literature . A 2‐year‐old child received a fivefold overdose when unlabelled oral syringes of nadolol (CORGARD) and flecainide were used.…”

Section: Life‐threatening Errors With Flecainide Suspension In Childrenmentioning

confidence: 99%

Medication Safety

2015

J Pharm Pract Res

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Life-Threatening Flecainide Intoxication in a Young Child Secondary to Medication Error

Abstract: This case of life-threatening flecainide intoxication in a young child, secondary to accidental reversal of medication syringes, underscores the importance of providing parents with accurate dispensing information and labeling medication bottles and syringes in an unambiguous manner.

Cited by 25 publications

References 22 publications

A Case of Near-fatal Flecainide Overdose in a Neonate Successfully Treated with Sodium Bicarbonate

A Case of Near-fatal Flecainide Overdose in a Neonate Successfully Treated with Sodium Bicarbonate

Patient-Controlled Analgesia Basal Infusion Overdose; Life-threatening Errors with Flecainide Suspension in Children; Medical Product Error-Prevention Efforts Need to be Shared and Harmonized Internationally

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