ABC | Volume 110, Nº3, March 2018

Case Report Gil et al. Propafenone Intoxication Arq Bras Cardiol. 2018; 110(3):292-294 Table 1 – Clinical Signs and Symptoms of Propafenone Intoxication, adapted from Clarot et al 4 Nausea Vomiting Metabolic acidosis Blurred vision and sleepiness Hypotonia Seizure Respiratory depression Coma Sinus Bradycardia Sinus arrest Atrial Fibrillation AV Block Intraventricular conduction disorders (QRS widening, Right Bundle Block) Hypotension Acute load of the right ventricle Cardiac failure Cardiovascular collapse Cardiac arrest 1. Wozakowska-Kaplon B, Stepien-Walek A. Propafenone overdose: cardiac arrest and full recovery. Cardiol J. 2010; 17(6):619-22. 2. Stancak B, Markovic P, Rajnic A, Petrikova V. Acute toxicity of propafenone in a case of suicidal attempt. Bratisl Lek Listy. 2004;105(1):14-7. 3. Saz EU, Ucar SK, Ulger Z, Ersel M, Cevik C, Karapinar B. Successful treatment of suicidal mega dose of propafenone intoxication - a case report. Kardiol Pol. 2010;68(11):1284-5. 4. Clarot F, Goulle JP, Horst M, Vaz E, Lacroix C, Proust B. Fatal propafenone overdoses: case reports and a review of the literature. J Anal Toxicol. 2003;27(8):595-9. 5. Ardi I, Gunebakmaz O, Yarlioglues M, Kaya MG. Acute intoxication with propafenone and trimethoprim-sulfamethoxazole in a case of suicide attempt. Turk Kardiyol Dern Ars. 2009;37(6):410-3. 6. Connolly SJ, Kates RE, Lebsack CS, Harrison DC, Winkle RA. Clinical pharmacology of propafenone. Circulation. 1983;68(3):589-96. 7. Siddoway LA, Roden DM, Woosley RL. Clinical pharmacology of propafenone: pharmacokinetics, metabolism and concentration-response relations. Am J Cardiol. 1984;54(9):9D-12D. 8. Antzelevitch C, Brugada P, Borggrefe M, Brugada J, Brugada R, Corrado D, et al. Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation. 2005;111(5):659-70. Erratum in: Circulation. 2005;112(4):e74. 9. Yiginer O, Kilicaslan F, Tokatli A, Işılak Z. [Concealed Brugada syndrome that became apparent incidentally during atrial fibrillation therapy]. Turk Kardiyol Dern Ars. 2011;39(2):159-62. 10. Matana A, Goldner V, Stanic K, Mavrić Z, Zaputović L, Matana Z. Unmasking effect of propafenone on the concealed formof the Brugada phenomenon. Pacing Clin Electrophysiol. 2000;23(3):416-8. 11. Beldner S, Lin D, Marchlinski FE. Flecainide and propafenone induced ST- segmentelevationinpatientswithatrialfibrillation:cluetospecificityofBrugada- type electrocardiographic changes. Am J Cardiol. 2004;94(9):1184-5. References This is an open-access article distributed under the terms of the Creative Commons Attribution License required. Peak serum concentration occurs between 2 and 3 h after ingestion, 4 during which time the most life-threatening ECG changes may occur. Both cases are paradigmatic in how unpredictable propafenone overdosing can be. It can range from an almost benign set of symptoms to a catastrophic presentation resulting in death. The first case presented the most important clinical warning signs, namely cardiac failure, conduction disturbance, and seizures. However, thanks to immediate treatment, the patient survived. The second case was critical as well, considering the seizing and extreme bradycardia requiring advanced life support; however, after the initial catastrophic presentation, clinical stability was maintained throughout the following hours. Another interesting aspect was the fact that a type-1 Brugada pattern was revealed. In both cases, no direct treatment for propafenone intoxication was available. Close monitoring and prompt supportive measures are crucial in assuring a good outcome Author contributions Conception and design of the research and Writing of the manuscript: Gil J; Acquisition of data and Analysis and interpretation of the data: Gil J, Marmelo B, Abreu L Antunes H; Critical revision of the manuscript for intellectual content: Santos LF, Cabral JC. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. 294