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Case Reports
. 2020 Sep 1;59(17):2191-2195.
doi: 10.2169/internalmedicine.4676-20. Epub 2020 May 26.

Pilsicainide Intoxication with Neuropsychiatric Symptoms Treated with Continuous Hemodiafiltration

Marina Asano  1 , Takuto Hayakawa  1 , Yuki Kato  1 , Kyogo Kawada  1 , Shuji Goto  1 , Joel Branch  2 , Hideaki Shimizu  1
Affiliations
Case Reports

Pilsicainide Intoxication with Neuropsychiatric Symptoms Treated with Continuous Hemodiafiltration

Marina Asano et al. Intern Med. .

Abstract

A 72-year-old lady with atrial fibrillation and chronic renal failure was hospitalized due to bradycardic shock with electrocardiographic QRS prolongation. She had experienced limb shaking two days before hospitalization, and additionally developed hallucinations one day before admission. Pilsicainide intoxication was diagnosed from a review of her medications and electrocardiographic findings. Consequently, continuous hemodiafiltration was performed resulting in a resolution of the hallucinations and the QRS prolongation. This is a rare case of psychiatric symptoms caused by pilsicainide intoxication. It is important to know the mode of excretion of a drug and to adjust its dose, so that such drug-related incidents can be avoided.

Keywords: continuous hemodiafiltration; pilsicainide; psychiatric symptoms.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Electrocardiographic findings. (A) Electrocardiogram with a wide QRS complex of 160 ms duration recorded before starting dialysis. (B) Electrocardiogram recorded 8 hours after starting dialysis. (C) Electrocardiogram with a non-sustained ventricular tachycardia recorded 10 hours after starting dialysis. (D) Electrocardiogram recorded 40 hours after starting dialysis.
Figure 2.
Figure 2.
Clinical course of this patient. Left Y axis is the serum concentration of pilsicainide (μg/mL) and right Y axis is blood pressure (mmHg) and heart rate (/min). HD: hemodialysis, CHD: continuous hemofiltration, CHDF: continuous hemodiafiltration
See this image and copyright information in PMC

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