II. Pharmacokinetics
- See Flecainide
III. Risk Factors
- Acute ingestion >1 gram
- Chronic dosing error
- Renal dysfunction
IV. Adverse Effects
V. Diagnostics
-
Electrocardiogram (EKG)
- QRS Widening
- Prolonged PR Interval
- Terminal R Wave in aVR (last 40 ms)
VI. Labs
- See Unknown Ingestion
- Bedside Glucose
- Basic chemistry panel with Electrolytes
- Serum Calcium
- Serum Magnesium
- Toxicology labs (including Acetaminophen level)
VII. Management
- Activated Charcoal in alert patient (no aspiration risk) and within one hour of ingestion
-
Electrolyte disturbance
- Potassium Replacement as needed for Hypokalemia
- Magnesium Replacement as needed
-
Hypotension
- Initial
- Intravenous Fluids
- Norepinephrine for Hypotension refractory to fluids
- Refractory Hypotension
- Intravenous Lipid Emulsion (Intralipid) 20% 1.5 ml/kg to 100 ml bolus (may be repeated)
- Extracorporeal Cardiopulmonary Resuscitation (ECMO)
- Initial
-
Wide QRS
- Hypertonic Sodium Bicarbonate IV with target pH 7.44 to 7.55
-
Ventricular Tachycardia
- Consider Amiodarone or Lidocaine
VIII. References
- Tomaszewski (2022) Crit Dec Emerg Med 36(3): 28
- Vu (2015) HeartRhythm Case Rep 2(3):228-31+PMID:28491675 [PubMed]