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Bicarbonate therapy for unstable propafenone-induced wide complex tachycardia

Published online by Cambridge University Press:  21 May 2015

Jeff Brubacher
Jeff Brubacher*
Affiliation:
Vancouver General Hospital, Vancouver, BC, and Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, BC, and British Columbia Drug and Poison Information, Vancouver, BC
*
[email protected]

Abstract

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A previously healthy 73-year-old woman presented to hospital with acute atrial fibrillation. After intravenous procainamide failed to restore sinus rhythm, she was treated with 300 mg of oral propafenone and discharged with a prescription for propafenone and propranolol. Six hours later she took 150 mg of propafenone as prescribed. Within 1 hour she became dyspneic and collapsed. On arrival in hospital she was unconscious, with a wide complex tachycardia and no obtainable blood pressure. After defibrillation and lidocaine, she converted to a wide complex sinus rhythm, but remained profoundly hypotensive despite intravenous epinephrine and dopamine. Hypertonic sodium bicarbonate (HCO3) was administered and, shortly thereafter, her blood pressure increased, her QRS duration normalized and her clinical status improved dramatically. In this case of severe refractory propafenone-related cardiac toxicity, intravenous HCO3 led to a profound clinical improvement. Emergency physicians should be familiar with the syndrome of sodium-channel blocker poisoning and recognize the potentially important role of bicarbonate in its treatment.

Keywords

propafenonesodium channel blockersanti-arrhythmia agentsadverse effectsatrial fibrillation
Type
Pharmacotherapy • Pharmacothérapie
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 5 , September 2004 , pp. 349 - 356
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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