Ozeki S, Utsunomiya T, Matsuo S, Yano K
Department of Cardiology, Saga National Hospital, Japan.
Jpn Circ J. 1999 Mar;63(3):219-22. doi: 10.1253/jcj.63.219.
An 81-year-old woman developed pilsicainide intoxication associated with dehydration. The patient had been taking pilsicainide (100 mg/day) for 1 year because of paroxysmal atrial fibrillation. Her renal function was within normal limits. One week before admission, she was suffering from pneumonia, and had appetite loss, fever, and severe fatigue. Physical examination revealed dehydration. The electrocardiogram (ECG) on admission showed atrioventricular dissociation, idioventricular rhythm with marked QRS widening and QTc prolongation. The plasma concentration of pilsicainide on admission was markedly elevated at 6.2 microg/ml, approximately 6 times the therapeutic range (0.25-1.0 microg/ml). Continuous saline infusion was initiated for the treatment of dehydration,which progressively improved. As a result, sinus rhythm was recovered 2 h after admission, and the QRS and JT intervals gradually normalized. This is an interesting case because the proarrhythmia of pilsicainide was induced by dehydration.
一名81岁女性发生了与脱水相关的吡西卡尼中毒。该患者因阵发性心房颤动服用吡西卡尼（100毫克/天）已有1年。她的肾功能在正常范围内。入院前一周，她患了肺炎，出现食欲减退、发热和严重疲劳。体格检查发现脱水。入院时心电图显示房室分离、室性自主心律伴明显QRS波增宽和QTc延长。入院时吡西卡尼的血浆浓度显著升高，达6.2微克/毫升，约为治疗范围（0.25 - 1.0微克/毫升）的6倍。开始持续输注生理盐水治疗脱水，脱水情况逐渐改善。结果，入院后2小时恢复窦性心律，QRS波和JT间期逐渐恢复正常。这是一个有趣的病例，因为吡西卡尼的促心律失常作用是由脱水诱发的。
