Key result
The combination of electrolyte disturbances from vomiting and the administration of QT-prolonging medications (ondansetron, metoclopramide, and fluoxetine) led to acquired long QT syndrome and cardiac arrest.
Why the study?
Acquired long QT syndrome is an important and preventable cause of cardiac arrest, commonly driven by coexisting medications and electrolyte disturbances.
Case Report (n=1)
No
This case highlights the critical risk of acquired long QT syndrome and cardiac arrest when prescribing QT-prolonging medications to patients with electrolyte disturbances and concurrent QT-prolonging therapies.
Alerts to cumulative QT risks from drugs plus electrolytes; leaves open systematic quantification of each factor's contribution.
BACKGROUND: Acquired long QT syndrome is an important and preventable cause of cardiac arrest. Certain medications and electrolyte disturbance are common contributors, and often coexist. In this case, we report five contributors to cardiac arrest. CASE PRESENTATION: This case is of a 51-year-old Caucasian female patient who presented with vomiting associated with hypokalemia and hypomagnesemia. She subsequently received ondansetron and metoclopramide, on the background of chronic treatment with fluoxetine. She then suffered an in-hospital monitored cardiac arrest, with features of long QT and torsades de pointes retrospectively noted on her prearrest electrocardiogram. She was diagnosed with acquired long QT syndrome, and her QT interval later normalized after removal of offending causes. CONCLUSIONS: This case highlights the importance of proper consideration prior to prescribing QT prolonging medications, especially in patients who have other risk factors for prolonged QT, such as electrolyte disturbances and pretreatment with QT prolonging medications.
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Tiver et al. (2022) conducted a case report in Acquired long QT syndrome and cardiac arrest (n=1). QT-prolonging medications (ondansetron, metoclopramide, fluoxetine) and electrolyte disturbances was evaluated on Cardiac arrest and acquired long QT syndrome. The combination of electrolyte disturbances from vomiting and the administration of QT-prolonging medications (ondansetron, metoclopramide, and fluoxetine) led to acquired long QT syndrome and cardiac arrest.
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