Devin Ruth, Garrett Peter, Anstey Chris
Intensive Care Unit, Nambour General Hospital, Sunshine Coast, Queensland, Australia.
Emerg Med Australas. 2007 Apr;19(2):155-9. doi: 10.1111/j.1742-6723.2006.00909.x.
Flecainide overdose can rapidly result in profound cardiovascular collapse, and is associated with a relatively high mortality. A case is described where a woman with major toxicity and high serum levels was managed without recourse to invasive modalities such as cardiopulmonary bypass or extracorporeal therapies. Hypertonic sodium bicarbonate is recognized as effective therapy for hypotension and arrhythmias. More recent case reports have concentrated on the use of cardiopulmonary bypass. In this report and other reports describing successful resuscitation, the total dose of sodium bicarbonate is conspicuously higher than in reports describing extracorporeal interventions. Sodium bicarbonate should be given early in the resuscitation, and re-administered as frequently as required, targeting an alkaline pH and improved cardiac output, while accepting hypernatraemia. This case demonstrates the maxim that the correct dose of hypertonic sodium bicarbonate is 'enough'. Cardiopulmonary bypass support can be considered as a salvage therapy.
氟卡尼过量可迅速导致严重的心血管衰竭，并伴有相对较高的死亡率。本文描述了一例具有严重毒性且血清水平较高的女性患者，在未采用体外循环或体外治疗等侵入性手段的情况下得到了救治。高渗碳酸氢钠被认为是治疗低血压和心律失常的有效疗法。最近的病例报告主要集中在体外循环的应用上。在本报告以及其他描述成功复苏的报告中，碳酸氢钠的总剂量明显高于描述体外干预的报告。在复苏早期就应给予碳酸氢钠，并根据需要频繁重新给药，目标是使pH值呈碱性并改善心输出量，同时接受高钠血症。该病例证明了“正确剂量的高渗碳酸氢钠就是‘足够的剂量’”这一准则。体外循环支持可被视为一种挽救疗法。
