title: Primary and secondary detoxification in severe flecainide intoxication.
abstract: Since experience with primary and secondary detoxification in severe flecainide intoxications is limited, 2 different cases of flecainide intoxications are reported. In the first case, with plasma concentrations of 6500 ng/ml (therapeutic range: 200-980 ng/ml), the patient survived with a pacemaker and catecholamine support. In the second case, hemoperfusion terminated the need for emergency resuscitation during the initial phase, but was unsuccessful 3 h later. Even with a lower plasma concentration the patient died. Both patients had rapid onset of symptoms due to the very good bioavailability of the drug. Although it may be a rare intoxication, it is dangerous because of its quick onset and its efficiency in altering the cardiac stability. We recommend the prophylactic use of a pacemaker and gastric suction. The usefulness of hemoperfusion has not yet been proven.
authors.affiliation: Reanimationszentrum, Freie Universität Berlin, Klinikum Rudolf Virchow, Federal Republic of Germany.
authors.forename: D
authors.initials: D
authors.lastname: Götz
authors.forename: S
authors.initials: S
authors.lastname: Pohle
authors.forename: D
authors.initials: D
authors.lastname: Barckow
mesh_terms: D000293:Adolescent; D000328:Adult; D002304:Cardiac Pacing, Artificial; D002606:Charcoal / Q000008:administration & dosage / Q000627:therapeutic use; D005424:Flecainide / Q000097:blood / Q000506:poisoning*; D005751:Gastric Lavage; D006464:Hemoperfusion; D006801:Humans; D008297:Male; D011041:Poisoning / Q000097:blood / Q000628:therapy*
chemical_list: D002606:Charcoal; D005424:Flecainide