Monterrubio-Villar Jesús, Llinares-Moya David
Intensive Care Unit, Hospital Don Benito-Villanueva, Badajoz, Spain.
Eur J Case Rep Intern Med. 2020 Jan 1;7(2):001374. doi: 10.12890/2020_001374. eCollection 2020.
Brugada phenocopies (BrP) are clinical entities that present with an ECG pattern identical to either the type 1 or type 2 Brugada pattern without true congenital Brugada syndrome. This ECG pattern is associated with an identifiable condition and normalizes upon resolution or treatment of the underlying cause. We present a case of a 54-year-old man with extreme metabolic acidosis, hyperkalaemia and a Brugada type 1 ECG pattern in the setting of a suicidal methanol (MeOH) poisoning. Upon correction of these metabolic derangements with bicarbonate infusions and continuous veno-venous haemodiafiltration (CVVH), the Brugada type 1 ECG pattern normalized. Unfortunately, the patient developed signs of cerebral herniation followed by brain death and died on the first day of ICU admission.
Brugada-like ECG patterns are described in several metabolic conditions such as extreme hyperglycaemia, glucose/insulin challenge, isolated hyperkalaemia or in association with hyponatraemia and acidosis.Until now, there have been no published case reports of BrP in association with methanol intoxication.Correction of hyperkalaemia and acidosis and specific therapy for methanol intoxication leads to a complete resolution of a Brugada type 1 ECG pattern.
Brugada 拟表型（BrP）是指临床症状表现为心电图模式与 1 型或 2 型 Brugada 模式相同，但并非真正先天性 Brugada 综合征的情况。这种心电图模式与可识别的病症相关，并且在潜在病因得到解决或治疗后会恢复正常。我们报告一例 54 岁男性病例，该患者因自杀性甲醇（MeOH）中毒出现极端代谢性酸中毒、高钾血症及 1 型 Brugada 心电图模式。通过输注碳酸氢盐及持续静脉 - 静脉血液透析滤过（CVVH）纠正这些代谢紊乱后，1 型 Brugada 心电图模式恢复正常。不幸的是，患者出现脑疝迹象，随后脑死亡，并于入住重症监护病房的第一天死亡。
在多种代谢状况下会出现类似 Brugada 的心电图模式，如极端高血糖、葡萄糖/胰岛素激发试验、单纯性高钾血症或与低钠血症及酸中毒相关的情况。到目前为止，尚无关于 BrP 与甲醇中毒相关的病例报告发表。纠正高钾血症和酸中毒以及针对甲醇中毒的特异性治疗可使 1 型 Brugada 心电图模式完全恢复正常。
