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Case Reports in Cardiology
Volume 2019, Article ID 1905871, 5 pages
https://doi.org/10.1155/2019/1905871
Case Report

Cardiogenic Shock in a Hemodialyzed Patient on Flecainide: Treatment with Intravenous Fat Emulsion, Extracorporeal Cardiac Life Support, and CytoSorb® Hemoadsorption

1Department of Intensive Care, Clinique St-Pierre, 1340 Ottignies, Belgium
2Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, 1200 Brussels, Belgium
3Louvain Centre of Toxicology and Applied Pharmacology, Université catholique de Louvain, 1200 Brussels, Belgium
4Department of Clinical Chemistry, Cliniques St-Luc, Université catholique de Louvain, 1200 Brussels, Belgium
5Cardiovascular Intensive Care, Cliniques St-Luc, Université catholique de Louvain, 1200 Brussels, Belgium

Correspondence should be addressed to Philippe Hantson; eb.niavuolcu@nostnah.eppilihp

Received 22 February 2019; Revised 28 May 2019; Accepted 15 July 2019; Published 24 July 2019

Academic Editor: Assad Movahed

Copyright © 2019 Nicolas De Schryver et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 67-year-old woman with a history of end-stage renal disease on hemodialysis received a therapeutic dose (150 mg daily) of flecainide for three weeks. She was admitted to the Emergency Department for malaise and dizziness, and the electrocardiogram revealed ventricular tachycardia treated by amiodarone. Hemodynamic condition remained stable, and the toxicity of flecainide was initially not suspected until she developed within 8 hours a cardiogenic shock requiring vasopressors. The patient then received sodium bicarbonate (300 mmol) and dobutamine but experienced cardiac arrest two hours later. The administration of intravenous fat emulsion (IFE) was associated with return of spontaneous circulation, but there was a relapse of cardiovascular shock at the end of IFE infusion. The patient was placed on extracorporeal cardiac life support (ECLS), continuous hemofiltration, and hemoadsorption using the CytoSorb® cartridge. Serial determinations of serum flecainide concentration were obtained during the course of hemoadsorption, with a terminal half-life of 3.7 h during the first four hours and a global plasma clearance of 40.3 ml/min over the first 22 hours. The weaning of ECLS was possible on day 7. Intravenous fat emulsion infusion was followed by a significant increase in serum flecainide concentration. In addition, while conventional techniques of extrarenal epuration usually appear as poorly effective for flecainide removal, a mean plasma clearance of 40.3 ml/min was observed using the hemoadsorption technique based on CytoSorb® cartridge. However, the impact on the clinical course was probably extremely modest in comparison with ECLS.