Pharm

Flecainide Overdose

search

Flecainide Overdose, Flecainide Toxicity, Flecainide Poisoning

  • See Also
  1. Flecainide
  2. Unknown Ingestion
  • Pharmacokinetics
  1. See Flecainide
  • Risk Factors
  1. Acute ingestion >1 gram
  2. Chronic dosing error
  3. Renal dysfunction
  • Adverse Effects
  1. See Flecainide
  2. Seizures
  3. Hypotension
  4. Bradycardia
  5. Wide Complex Tachycardia
  • Diagnostics
  1. Electrocardiogram (EKG)
    1. QRS Widening
    2. Prolonged PR Interval
    3. Terminal R Wave in aVR (last 40 ms)
  • Labs
  1. See Unknown Ingestion
  2. Bedside Glucose
  3. Basic chemistry panel with Electrolytes
  4. Serum Calcium
  5. Serum Magnesium
  6. Toxicology labs (including Acetaminophen level)
  • Management
  1. Activated Charcoal in alert patient (no aspiration risk) and within one hour of ingestion
  2. Electrolyte disturbance
    1. Potassium Replacement as needed for Hypokalemia
    2. Magnesium Replacement as needed
  3. Hypotension
    1. Initial
      1. Intravenous Fluids
      2. Norepinephrine for Hypotension refractory to fluids
    2. Refractory Hypotension
      1. Intravenous Lipid Emulsion (Intralipid) 20% 1.5 ml/kg to 100 ml bolus (may be repeated)
      2. Extracorporeal Cardiopulmonary Resuscitation (ECMO)
  4. Wide QRS
    1. Hypertonic Sodium Bicarbonate IV with target pH 7.44 to 7.55
  5. Ventricular Tachycardia
    1. Consider Amiodarone or Lidocaine
  • References
  1. Tomaszewski (2022) Crit Dec Emerg Med 36(3): 28
  2. Vu (2015) HeartRhythm Case Rep 2(3):228-31+PMID:28491675 [PubMed]
    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419747/