title: Comparison of the therapeutic effect between sodium bicarbonate and insulin on acute propafenone toxicity.
abstract: OBJECTIVE
  Unlike other sodium-channel-blocking antiarrhythmic agents, propafenone has β-blocking effects and calcium-channel-blocking effects. Yi et al recently studied insulin's treatment effect on acute propafenone toxicity in rats. However, because the degree of effectiveness of insulin compared to the previously known antidote sodium bicarbonate (NaHCO3) was not studied, the 2 treatment methods were compared for propafenone intoxication in rats.
  
  
  METHODS
  Rats received intravenous propafenone (36 mg/[kg h]) for 12 minutes. After the induction of toxicity, rats (n = 10 per group) received normal saline solution (NSS), NaHCO3, or insulin with glucose as treatment. Animals in the NSS, NaHCO3, and Insulin groups received an intravenous infusion of 36 mg/(kg h) propafenone until death occurred. For each animal, the mean arterial pressure (MAP, heart rate, PR interval, QRS duration, total hemoglobin, sodium, potassium, potential of hydrogen, bicarbonate, glucose, lactate, and central venous oxygen saturation (Scvo2) were measured and compared among the groups.
  
  
  RESULTS
  Survival of the Insulin group was greater than that of the NSS group by log-rank test (P = .021). Sodium bicarbonate prevented the decline of MAP for 55 minutes. In comparison, insulin prevented the decline of MAP and heart rate, and the elongation of the PR interval and QRS duration for 55 minutes (P < .05). Propafenone toxicity led to decreased Ca(2+), potential of hydrogen, and Scvo2 and increased lactate levels. Insulin prevented the decrease of Ca(2+) and Scvo2, whereas NaHCO3 prevented the increase in lactate.
  
  
  CONCLUSIONS
  Insulin treatment was more effective than NaHCO3 on acute propafenone toxicity in rat. Therefore, when propafenone-induced cardiotoxicity occurs, which is unresponsive to current treatment methods, glucose-insulin infusion may be considered.
authors.affiliation: Department of Emergency Medicine, Graduate School Chungnam National University, Daejeon, Republic of Korea.
authors.forename: Hwa Yeon
authors.initials: HY
authors.lastname: Yi
authors.affiliation: Department of Emergency Medicine, College of Medicine, Eulji University, Daejeon, Republic of Korea. Electronic address: jylee1224@gmail.com.
authors.forename: Jang Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, College of Medicine, Eulji University, Daejeon, Republic of Korea.
authors.forename: Won Suk
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, College of Medicine, Eulji University, Daejeon, Republic of Korea.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Sung
authors.affiliation: Department of Emergency Medicine, College of Medicine, Eulji University, Daejeon, Republic of Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Seo
mesh_terms: D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000633:toxicity*; D062186:Arterial Pressure / Q000187:drug effects*; D001639:Bicarbonates / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects; D002118:Calcium / Q000097:blood; D055724:Electrophysiological Phenomena / Q000187:drug effects*; D005947:Glucose / Q000494:pharmacology; D006321:Heart / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects*; D006454:Hemoglobins / Q000187:drug effects; D007328:Insulin / Q000494:pharmacology*; D019344:Lactic Acid / Q000097:blood; D010092:Oximetry; D011188:Potassium / Q000097:blood; D011405:Propafenone / Q000633:toxicity*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012964:Sodium / Q000097:blood; D017693:Sodium Bicarbonate / Q000494:pharmacology*; D015996:Survival Rate
chemical_list: D000889:Anti-Arrhythmia Agents; D001639:Bicarbonates; D001786:Blood Glucose; D006454:Hemoglobins; D007328:Insulin; D019344:Lactic Acid; D011405:Propafenone; D017693:Sodium Bicarbonate; D012964:Sodium; D005947:Glucose; D011188:Potassium; D002118:Calcium