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Yan S, Xin T, Luo X, Wang Y, Chen B. A case of lethal suicidal intoxication with propafenone and diazepam. Ann Noninvasive Electrocardiol 2024; 29:e13111. [PMID: 38439207 PMCID: PMC10912523 DOI: 10.1111/anec.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/06/2024] [Accepted: 02/19/2024] [Indexed: 03/06/2024] Open
Abstract
Diazepam poisoning is a common emergency situation, but propafenone poisoning is relatively rare. We reported a case of propafenone poisoning combined with diazepam. An 18-year-old female patient was admitted to our hospital with an overdose of oral propafenone and diazepam. The patient was treated with medication that proved to be useful, but the sinus rhythm could not be recovered, and cardiac arrest occurred. A bipolar temporary pacemaker and extracorporeal membrane oxygenation (ECMO) were installed. However, even with multiple electrode positions, effective capture could not be achieved. The patient eventually died. We should be alert to the possibility of co-poisoning.
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Affiliation(s)
- Shuangbing Yan
- Department of CardiologyTianjin First Central HospitalTianjinChina
| | - Ting Xin
- Department of CardiologyTianjin First Central HospitalTianjinChina
| | - Xiaojie Luo
- Department of EmergencyTianjin First Central HospitalTianjinChina
| | - Yu Wang
- Department of EmergencyTianjin First Central HospitalTianjinChina
| | - Bingwei Chen
- Department of CardiologyTianjin First Central HospitalTianjinChina
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Keramari S, Poutoglidis A, Poutoglidou F, Kaiafa G, Keramaris M. Propafenone Poisoning of a Female Adolescent After a Suicide Attempt. Cureus 2021; 13:e16576. [PMID: 34434676 PMCID: PMC8380293 DOI: 10.7759/cureus.16576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/09/2022] Open
Abstract
Propafenone is an antiarrhythmic agent for the management of ventricular and supraventricular tachycardia and atrial fibrillation. Propafenone poisoning is rare but may be life-threatening due to drug-induced arrhythmias. Electrocardiographic changes in PR, QRS, and QT intervals have been recorded. We present a case of a 15-year-old female adolescent who developed arrhythmias and convulsions due to propafenone intoxication, in an attempt to commit suicide. The outcome of the case was a full recovery from the arrhythmias and the seizures. The aim of this article is to highlight the possibility of a lethal intoxication by a common antiarrhythmic drug. Our case aims to present our therapeutic strategy that relies mainly on close monitoring of patients and cardiac output support.
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Affiliation(s)
- Stergiani Keramari
- Second Department of Paediatrics, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Alexandros Poutoglidis
- Otorhinolaryngology - Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Frideriki Poutoglidou
- Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Georgia Kaiafa
- First Propaedeutic Department of Internal Medicine, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Farooq M, Qureshi F, Kamkoum W, Abuzeyad F. Propafenone and propranolol dual toxicity. J Am Coll Emerg Physicians Open 2020; 1:1104-1107. [PMID: 33145565 PMCID: PMC7593489 DOI: 10.1002/emp2.12126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/07/2022] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
Propranolol is a highly lipid-soluble beta-receptor antagonist and propafenone is a potent class 1c anti-arrhythmic agent with strong Na-channel blockade effect. We describe a novel case of dual overdose of propafenone and propranolol resulting in hypotension, generalized seizures, and reduced level of consciousness that was successfully treated. A 52-year-old female ingested 500 mg of propranolol and 1.5 g of propafenone. The patient was brought to the emergency department (ED) and exhibited signs of systemic toxicity and reduced level of consciousness. The patient was treated as a case of combined β-blocker and propafenone toxicity using high dose insulin, NaHCO3, glucagon, atropine, and dopamine. She started improving and becoming more alert, with subsequent ECGs revealing normal sinus rhythm. The patient was discharged 4 days later. We believe that early administration of NaHCO3 should be administered in patients exhibiting signs of Na-channel blockade.
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Affiliation(s)
- Moonis Farooq
- Emergency DepartmentKing Hamad University HospitalBusaiteenKingdom of Bahrain
| | - Faisal Qureshi
- Emergency DepartmentKing Hamad University HospitalBusaiteenKingdom of Bahrain
| | - Wael Kamkoum
- Emergency DepartmentKing Hamad University HospitalBusaiteenKingdom of Bahrain
| | - Feras Abuzeyad
- Emergency DepartmentKing Hamad University HospitalBusaiteenKingdom of Bahrain
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Marano M, Goffredo BM, Pisani M, Filippelli S, Cecchetti C, Drago F, Barbieri MA, Nunziata J, Genuini L, Di Nardo M. Pediatric extracorporeal cardiopulmonary resuscitation settled in an emergency department for a propafenone intentional intoxication. Am J Emerg Med 2018; 36:2132.e1-2132.e3. [PMID: 30082186 DOI: 10.1016/j.ajem.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/29/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022] Open
Abstract
The use of drugs in suicide attempts is becoming more and more frequent among adolescents. Intentional intoxication with propafenone is very rare and mainly reported in adults associated with other drugs. The therapeutic approach is symptomatic, since there is no specific antidote for propafenone. We present a pediatric case of intentional ingestion of 1.8 g of propafenone that caused refractory cardiogenic shock. The patient was successfully rescued with extracorporeal cardiopulmonary resuscitation in the emergency department of a secondary level peripheral hospital.
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Affiliation(s)
- Marco Marano
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Bianca M Goffredo
- Laboratory of Analytical Biochemistry, IRCCS, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Mara Pisani
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital Bambino Gesù, Rome, Italy
| | - Corrado Cecchetti
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital Bambino Gesù, Rome, Italy
| | - Maria A Barbieri
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Joseph Nunziata
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.
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Ling B, Geng P, Tan D, Walline J. Full recovery after prolonged resuscitation from cardiac arrest due to propafenone intoxication: A case report. Medicine (Baltimore) 2018; 97:e0285. [PMID: 29642149 PMCID: PMC5908564 DOI: 10.1097/md.0000000000010285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The prognosis of cardiac arrest (CA) induced by propafenone intoxication was thought to be very poor. The maximal duration of cardiopulmonary resuscitation (CPR) for propafenone induced CA is unknown. PATIENT CONCERNS We describe a case that was successfully resuscitated after prolonged CPR (totaling 340 minutes during one hospital visit) for propafenone intoxication without subsequent neurological sequela. DIAGNOSES A previously healthy 36-year-old female who developed multiple and prolonged CAs after consuming 98 tablets of 50mg propafenone. The CPR duration of this case, to the best of our knowledge, is the longest of all existing propafenone-induced CPR events to still have full recovery. We also analyse the contributing factors to this successful CPR. INTERVENTIONS Sodium bicarbonate, inotropic drugs and pacemaker application did not prevent the occurrence of CA. A full recovery was eventually achieved after prolonged CPR with a mechanical CPR device, blood purification and other aggressive supportive treatments. OUTCOMES Full recovery without neurological sequela. LESSONS Prolonged CPR including the application of mechanical CPR devices should be considered in propafenone-related CA, especially in young patients without significant comorbidities and delayed resuscitation.
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Affiliation(s)
- Bingyu Ling
- Department of Emergency Medicine, Northern Jiangsu People's Hospital, Yangzhou China
| | - Ping Geng
- Department of Emergency Medicine, Northern Jiangsu People's Hospital, Yangzhou China
| | - Dingyu Tan
- Department of Emergency Medicine, Northern Jiangsu People's Hospital, Yangzhou China
| | - Joseph Walline
- Division of Emergency Medicine, Department of Surgery, Saint Louis University Hospital, Saint Louis, Missouri, USA
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Chen X, Yang Z. Successful treatment of propafenone-induced cardiac arrest by calcium gluconate. Am J Emerg Med 2017; 35:1209.e1-1209.e2. [PMID: 28390833 DOI: 10.1016/j.ajem.2017.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/31/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022] Open
Abstract
Propafenone is prescribed for the control of cardiac ventricular arrhythmias. Poisoning from propafenone intoxication is rare, but the survival rate of patients is low. We present a case of a 37-year-old man who developed cardiac arrest due to propafenone intoxication. Cardiopulmonary resuscitation, plasmapheresis, and other medical treatments had no effect on cardiac arrest. After repeated administrations of calcium gluconate, the patient achieved a full recovery. To the best of our knowledge, this is the first case report in which a full recovery from cardiac arrest was achieved by administration of calcium gluconate. We recommend that for patients poisoned by propafenone, close monitoring for decreased blood calcium is important.
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Affiliation(s)
- Xiaoyu Chen
- Department of Emergency Room, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Zhejiang, China
| | - Zaixing Yang
- Department of Laboratory Medicine, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Zhejiang, China.
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Bayram B, Köse I, Avcı S, Arslan A, Acara Ç. Successful Treatment of Propafenone Intoxication With Intravenous Lipid Emulsion. Pharmacotherapy 2016; 35:e149-52. [PMID: 26497484 DOI: 10.1002/phar.1637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Severe cardiac effects, including cardiac arrest, are a rare complication of high-dose propafenone intake. Among patients who experience cardiac arrest, the survival rate is low. This report presents the case of a young female patient who developed cardiac arrest linked to propafenone intake. While spontaneous circulation was restored with cardiopulmonary resuscitation, vital signs did not recover despite supportive treatment. However, after the administration of intravenous lipid emulsion (ILE), vital signs and cardiac functions resolved and the patient survived. This case is the second to describe the successful use of ILE for propafenone intoxication. However, as all of the findings of this patient were clearly linked to propafenone, we believe the benefits of ILE were more clearly defined in this case than in the other.
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Affiliation(s)
- Başak Bayram
- Department of Emergency Medicine, Dokuz Eylul University School of Medicine, Inciralti, Izmir, Turkey
| | - Işıl Köse
- Clinic of Anesthesiology and Reanimation, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sinem Avcı
- Department of Emergency Medicine, Dokuz Eylul University School of Medicine, Inciralti, Izmir, Turkey
| | - Abdulla Arslan
- Department of Cardiology, Dokuz Eylul University School of Medicine, Inciralti, Izmir, Turkey
| | - Çağdaş Acara
- Department of Emergency Medicine, Dokuz Eylul University School of Medicine, Inciralti, Izmir, Turkey
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Yi HY, Lee JY, Lee WS, Sung WY, Seo SW. Comparison of the therapeutic effect between sodium bicarbonate and insulin on acute propafenone toxicity. Am J Emerg Med 2014; 32:1200-7. [PMID: 25151327 DOI: 10.1016/j.ajem.2014.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/06/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022] Open
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