Cocaine-induced wide complex dysrhythmia.
Cocaine is a local anesthetic with the potential to induce dysrhythmia due to direct myocardial sodium channel antagonism similar to class I antidysrhythmic drugs. The hallmark of myocardial sodium channel poisoning is wide complex dysrhythmia, and the current accepted treatment is intravenous bicarbonate. Wide complex dysrhythmio due to cocaine in the absence of myocardial infarction is rare, and optimum management is undefined. We report three cases of acute cocaine intoxicating during which patients developed wide complex dysrhythmia consistent with sodium channel poisoning. In one case, wide complex tachycardia resolved without direct treatment. In the other cases, wide complex dysrhythmia resolved following intravenous bicarbonate therapy directed at reversing sodium channel blockade.
Kerns
W
W
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA.
Garvey
L
L
Owens
J
J
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D003042:Cocaine / Q000506:poisoning*; D004562:Electrocardiography; D004830:Epilepsy, Tonic-Clonic / Q000139:chemically induced; D005260:Female; D006801:Humans; D008297:Male; D009294:Narcotics / Q000506:poisoning*; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D015222:Sodium Channels / Q000187:drug effects
D009294:Narcotics; D015222:Sodium Channels; D017693:Sodium Bicarbonate; D003042:Cocaine