Acute intoxication with propafenone and trimethoprim-sulfamethoxazole in a case of suicide attempt.
A 17-year-old male ingested about 20 tablets of propafenone (total 6,000 mg) and 24 tablets of trimethoprim (total 1,920 mg)--sulfamethoxazole (total 9,600 mg) with suicidal intent. Within one hour, he was brought to a hospital with vomiting, nausea, and loss of consciousness, where he developed cyanosis and mild acidosis, and eventually cardiorespiratory arrest, despite bicarbonate, saline infusion, and inotropic support. Fortunately, he was fully resuscitated and ventilated, and sinus rhythm was restored. He was then transported to our center. On admission, his heart rate was regular with 55 beats/min and blood pressure was 70/45 mmHg. The 12-lead electrocardiogram (ECG) showed sinus bradycardia, extreme widening of the QRS complex (260 msec) with a right bundle branch block pattern. Intravenous saline, bicarbonate, and dopamine were administered, and respiration was supported mechanically, which resulted in rapid restoration of sinus rhythm and improvement in hemodynamic parameters and acidosis. A subsequent ECG showed shortening of the QRS duration (230 msec). He was discharged with an appropriate hemodynamic balance on the third day with normal ECG findings.
Ardiç
Idris
I
Department of Cardiology, Medicine Faculty of Erciyes University, Kayseri, Turkey.
Günebakmaz
Ozgür
O
Yarlioglues
Mikail
M
Kaya
Mehmet Güngör
MG
D000138:Acidosis / Q000139:chemically induced; D001639:Bicarbonates / Q000627:therapeutic use; D003490:Cyanosis / Q000139:chemically induced; D004298:Dopamine / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D011405:Propafenone / Q000633:toxicity*; D012965:Sodium Chloride / Q000627:therapeutic use; D013406:Suicide, Attempted; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000633:toxicity*
D001639:Bicarbonates; D012965:Sodium Chloride; D011405:Propafenone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004298:Dopamine