{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:28:27Z","timestamp":1756384107882,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,11,15]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>A 63-year-old woman on flecainide, furosemide, and triamterene\u2013hydrochlorothiazide presented with weakness and diarrhoea. She had profound hyponatraemia, hypokalaemia and a pre-renal acute kidney injury (AKI). Her ECG showed a regular wide complex tachycardia concerning for monomorphic ventricular tachycardia. She was haemodynamically stable and treated with aggressive electrolyte repletion and amiodarone. Flecainide toxicity can present as a variety of arrhythmias and early recognition is crucial. This case focuses on flecainide toxicity from multiple concomitant insults: diuretic use, diarrhoea, hypokalaemia, hyponatraemia and pre-renal AKI. We emphasise the importance of close outpatient monitoring of electrolytes in a patient on diuretics and flecainide to prevent life-threatening arrhythmias. We discourage use of multiple diuretics in patients taking flecainide.<\/jats:p>","DOI":"10.1136\/bcr-2020-236932","type":"journal-article","created":{"date-parts":[[2020,12,13]],"date-time":"2020-12-13T23:30:34Z","timestamp":1607902234000},"page":"e236932","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Fast and furious: flecainide toxicity presenting as monomorphic ventricular tachycardia"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2718-2663","authenticated-orcid":false,"given":"Nisha","family":"Donthi","sequence":"first","affiliation":[{"name":"Inova Fairfax Medical Campus, Falls Church, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tejasri","family":"Chandrabhatla","sequence":"additional","affiliation":[{"name":"Inova Fairfax Medical Campus, Falls Church, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard","family":"Genovese","sequence":"additional","affiliation":[{"name":"Inova Heart and Vascular Institute, Falls Church, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"deFilippi","sequence":"additional","affiliation":[{"name":"Inova Heart and Vascular Institute, Falls Church, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,13]]},"reference":[{"key":"2025082706505502000_13.12.e236932.1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euq382"},{"key":"2025082706505502000_13.12.e236932.2","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.hrcr.2015.12.013","article-title":"Management of life-threatening flecainide overdose: a case report and review of the literature","volume":"2","author":"Vu","year":"2016","journal-title":"HeartRhythm Case Rep"},{"key":"2025082706505502000_13.12.e236932.3","doi-asserted-by":"publisher","DOI":"10.3109\/15563659009038586"},{"key":"2025082706505502000_13.12.e236932.4","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1161\/CIRCULATIONAHA.118.036071","article-title":"Unusual wide complex tachycardia during rhythm control for atrial fibrillation","volume":"138","author":"Banavalikar","year":"2018","journal-title":"Circulation"},{"key":"2025082706505502000_13.12.e236932.5","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ahj.2018.06.018","article-title":"Ventricular arrhythmia and death among atrial fibrillation patients using anti-arrhythmic drugs","volume":"205","author":"Friberg","year":"2018","journal-title":"Am Heart J"},{"key":"2025082706505502000_13.12.e236932.6","doi-asserted-by":"crossref","first-page":"E65","DOI":"10.1016\/j.ijcard.2006.07.124","article-title":"Torsade-de-pointes in a patient under flecainide treatment, an unusual case of proarrhythmicity","volume":"114","author":"Nogales Asensio","year":"2007","journal-title":"Int J Cardiol"},{"key":"2025082706505502000_13.12.e236932.7","doi-asserted-by":"crossref","first-page":"e84-6","DOI":"10.1111\/j.1540-8159.2010.02935.x","article-title":"Flecainide-associated bradycardia-dependent torsade de pointes: another potential mechanism of proarrhythmia","volume":"36","author":"Kim","year":"2013","journal-title":"Pacing Clin Electrophysiol"},{"key":"2025082706505502000_13.12.e236932.8","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2001.00119.x"},{"key":"2025082706505502000_13.12.e236932.9","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2006.044362"},{"key":"2025082706505502000_13.12.e236932.10","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.hrcr.2019.05.007","article-title":"A case of electrolyte disturbances leading to flecainide toxicity at normal serum levels and pacemaker malfunction","volume":"5","author":"Kasia","year":"2019","journal-title":"HeartRhythm Case Rep"},{"key":"2025082706505502000_13.12.e236932.11","doi-asserted-by":"crossref","first-page":"e87-9","DOI":"10.1111\/j.1540-8159.2012.03485.x","article-title":"A life-threatening flecainide overdose treated with intravenous fat emulsion","volume":"36","author":"Ellsworth","year":"2013","journal-title":"Pacing Clin Electrophysiol"},{"key":"2025082706505502000_13.12.e236932.12","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.hrcr.2015.01.003","article-title":"Successful treatment of flecainide overdose with sustained mechanical circulatory support","volume":"1","author":"Mandawat","year":"2015","journal-title":"HeartRhythm Case Rep"},{"key":"2025082706505502000_13.12.e236932.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198908103210608"},{"key":"2025082706505502000_13.12.e236932.14","unstructured":"RxDrugLabels . 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