Post Your Cases > Flecainide overdose

18 year old patient, trache/vent/GT dependent with structurally normal heart received an accidental overdose of flecainide; he received 25 mL (500 mg) instead of 25 mg. He was brought into the ED with a profound wide complex bradyarrhythmia (no p-waves to speak of) and cardiogenic shock.

He was started on a sodium bicarbonate infusion as well as intralipid; he received a bolus of 0.25 m/kg/min x 1 hour and was then started on an infusion. Toxicology was consulted and they recommended infusion of 12 mg/kg/HOUR (700 mL intralipid/hour). Needless to say, the patient's blood looked like strawberry milk within 2 hours. Isoproterenol was also added to maintain adequate heart rate.

Unfortunately, the patient was not an ECMO candidate and the intralipid therapy was not enough to save him; he had a bradycardic arrest several hours later.

I do not think the high lipid dose had anything to do with the arrest; it did make getting lab results a little more time consuming.

Thanks for any comments!
December 14, 2018 | Unregistered CommenterM.B MD