CASH as a mnemonic for indications of sodium bicarbonate for sodium channel blocker intoxication

Three Cases of Cardiac Arrest with Massive Flecainide Intoxication Treated with Extracorporeal Assistance

Flecainide acetate is a Vaughan Williams class 1C anti-arrhythmic agent. Overdose causes severe cardiac and neurologic disturbances and carries a risk of fatality. No antidote is currently available.We present three cases of massive flecainide intoxication in which the patients were kept alive by extracorporeal circulation. Extracorporeal support in cases of flecainide intoxication is the only approach that can alleviate acute cardiac dysfunction, preserve blood flow to vital organs, and maintain liver metabolism and renal excretion of the toxin, while waiting for the improvement of cardiac function. Furthermore, clinical practice highlights that age, duration of CPR, PH, and lactate levels should not be a hindrance to decision-making, and demonstrates the positive, long-term neurologic and cardiologic outcomes that can be achieved with the use of extracorporeal assistance in the setting of severe flecainide intoxication.

Ventricular Tachycardia or not? An Unexpected Reason of Wide QRS Complex Tachycardia in a Young Healthy Man: Sodium Bicarbonate

Ventricular tachycardia (VT) is life-threatening subgroup of wide QRS complex tachycardia (WCT). VT is usually associated with structural heart diseases, but it can occur in the absence of any cardiovascular diseases. Adverse cardiac effect of sodium bicarbonate in healthy subjects is not well described. A 30-year-old healthy man with excessive intake of sodium bicarbonate-related VT is presented. He was using sodium bicarbonate during last 2 months to lose weight. He has no risk factors and any cardiovascular or systemic diseases. After intravenous administration of amiodarone, tachycardia ended and his rhythm converted to sinus rhythm with normal electrocardiogram. Patient is asymptomatic, and no VT was observed without any medications at 1 year of follow-up.