Yasui R K, Culclasure T F, Kaufman D, Freed C R
Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
Ann Emerg Med. 1997 May;29(5):680-2. doi: 10.1016/s0196-0644(97)70257-9.
Flecainide toxicity can impair cardiac function and precipitate circulatory collapse, which in turn depresses clearance and redistribution of flecainide. Treatment directed at improving cardiac function is often ineffective in the presence of persistently increased flecainide levels. We report a novel approach to severe flecainide overdose using peripheral cardiopulmonary bypass support (CBS) to maintain perfusion of the liver, thereby allowing clearance of the drug. CBS was initiated to resuscitate a young woman who had ingested flecainide in a suicide attempt. The patient had an agonal rhythm, no effective blood pressure, and a flecainide level of 5.4 micrograms/mL (therapeutic range, .2 to 1.0 microgram/mL). During 10 hours of CBS, the flecainide level decreased to 1.4 micrograms/mL, a half-life of 6 hours. Effective cardiac rhythm and blood pressure returned. CBS successfully supported this patient until the flecainide level decreased as a result of redistribution and normal clearance mechanisms. Unfortunately, because of severe neurologic damage sustained at the time of overdose, the patient died 4 days after admission.
氟卡尼中毒可损害心脏功能并引发循环衰竭，进而抑制氟卡尼的清除和再分布。在氟卡尼水平持续升高的情况下，旨在改善心脏功能的治疗往往无效。我们报告了一种治疗严重氟卡尼过量的新方法，即使用外周体外循环支持（CBS）来维持肝脏灌注，从而促进药物清除。启动CBS是为了抢救一名试图自杀而摄入氟卡尼的年轻女性。患者呈濒死心律，无有效血压，氟卡尼水平为5.4微克/毫升（治疗范围为0.2至1.0微克/毫升）。在CBS治疗的10小时内，氟卡尼水平降至1.4微克/毫升，半衰期为6小时。恢复了有效的心律和血压。CBS成功地支持了该患者，直到氟卡尼水平因再分布和正常清除机制而降低。不幸的是，由于过量服药时遭受的严重神经损伤，患者在入院4天后死亡。
