Key result
Diuretic use and electrolyte derangements trigger flecainide toxicity presenting as monomorphic VT.
Why the study?
Flecainide toxicity can present as various arrhythmias and early recognition is crucial, especially in patients with multiple concomitant insults affecting electrolytes and kidney function.
Case Report (n=1)
Flecainide patients with diarrhoea or diuretics warrant electrolyte vigilance; leaves open whether proactive correction prevents toxicity.
A 63-year-old woman on flecainide, furosemide, and triamterene-hydrochlorothiazide presented with weakness and diarrhoea. She had profound hyponatraemia, hypokalaemia and a pre-renal acute kidney injury (AKI). Her ECG showed a regular wide complex tachycardia concerning for monomorphic ventricular tachycardia. She was haemodynamically stable and treated with aggressive electrolyte repletion and amiodarone. Flecainide toxicity can present as a variety of arrhythmias and early recognition is crucial. This case focuses on flecainide toxicity from multiple concomitant insults: diuretic use, diarrhoea, hypokalaemia, hyponatraemia and pre-renal AKI. We emphasise the importance of close outpatient monitoring of electrolytes in a patient on diuretics and flecainide to prevent life-threatening arrhythmias. We discourage use of multiple diuretics in patients taking flecainide.
No takes yet. Share an insight, caveat, or question.
Donthi et al. (2020) conducted a case report in Flecainide toxicity presenting as monomorphic ventricular tachycardia (n=1). Flecainide and multiple diuretics was evaluated. A 63-year-old woman developed flecainide toxicity presenting as monomorphic ventricular tachycardia due to multiple concomitant insults including diuretic use, diarrhoea, and electrolyte derangements.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: