eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Antidysrhythmic: Follow-up

Author: Joshua B Gaither, MD, Chief Resident, Department of Surgery, Section of Emergency Medicine, Yale New Haven Hospital
Coauthor(s): Carin M Van Gelder, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University; Consulting Staff and EMS Physician, SHARP Team, Division of Emergency Medical Services, Section of Emergency Medicine, Yale-New Haven Medical Center
Contributor Information and Disclosures

Updated: Jul 9, 2008

Follow-up

Further Inpatient Care

  • Arrange with cardiology or toxicology service for admission to a monitored bed in cardiac unit.

Further Outpatient Care

  • Inpatient admission to a monitored bed generally is required. Outpatient care can be arranged through the patient's primary physician or cardiologist.

Inpatient & Outpatient Medications

  • Continue inpatient treatment as described above.
  • Discontinue the precipitating antidysrhythmic agent.
  • Any outpatient medications are as recommended by the cardiologist.

Transfer

  • Arrange with cardiology or toxicologist for admission to a monitored intensive care bed.

Deterrence/Prevention

  • Avoid precipitating antidysrhythmic agent.

Complications

  • Observe for recurrent dysrhythmias for up to 48 hours.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Be cautious of patients using multiple drugs because this can obscure the clear identification of the proarrhythmic drug.
  • Ask family members or Emergency Medical Services personnel to bring all medications to the Emergency Department; this will help determine if accidental ingestion is the cause of the proarrhythmia.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Eileen C Quintana, MD, and Richard Sinert, DO, to the development and writing of this article.



More on Toxicity, Antidysrhythmic

Overview: Toxicity, Antidysrhythmic
Differential Diagnoses & Workup: Toxicity, Antidysrhythmic
Treatment & Medication: Toxicity, Antidysrhythmic
Follow-up: Toxicity, Antidysrhythmic
References
[ CLOSE WINDOW ]

References

  1. ATMAI. Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomised trials. Amiodarone Trials Meta-Analysis Investigators. Lancet. Nov 15 1997;350(9089):1417-24. [Medline].

  2. Bacaner M, Brietenbucher J, LaBree J. Prevention of ventricular fibrillation, acute myocardial infarction (myocardial necrosis), heart failure, and mortality by bretylium: is ischemic heart disease primarily adrenergic cardiovascular disease?. Am J Ther. Sep-Oct 2004;11(5):366-411. [Medline].

  3. Connolly SJ, Schnell DJ, Page RL, et al. Dose-response relations of azimilide in the management of symptomatic, recurrent, atrial fibrillation. Am J Cardiol. Nov 1 2001;88(9):974-9. [Medline].

  4. Ellenhorn MJ, ed. Antidysrhythmic agents toxicity. In: Ellenhorn's Medical Toxicology - Diagnosis and Treatment of Human Poisoning. 2nd ed. Lippincott Williams & Wilkins; 1997:498-551.

  5. Goldfrank L. Antidysrhythmic agent toxicity. In: Goldfrank's Toxicology Emergencies. McGraw-Hill;1994:715-25.

  6. Hoffman BF. Arrhythmias and antiarrhythmic drugs. Mt Sinai J Med. Mar 1997;64(2):136-41. [Medline].

  7. Hohnloser SH. Proarrhythmia with class III antiarrhythmic drugs: types, risks, and management. Am J Cardiol. Oct 23 1997;80(8A):82G-89G. [Medline].

  8. Juurlink DN, Mamdani M, Kopp A, et al. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA. Apr 2 2003;289(13):1652-8. [Medline].

  9. Kowey PR, Marinchak RA, Rials SJ, Bharucha D. Pharmacologic and pharmacokinetic profile of class III antiarrhythmic drugs. Am J Cardiol. Oct 23 1997;80(8A):16G-23G. [Medline].

  10. MacNeil DJ. The side effect profile of class III antiarrhythmic drugs: focus on d,l- sotalol. Am J Cardiol. Oct 23 1997;80(8A):90G-98G. [Medline].

  11. Naccarelli GV, Wolbrette DL, Khan M, et al. Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation: comparative efficacy and results of trials. Am J Cardiol. Mar 20 2003;91(6A):15D-26D. [Medline].

  12. Ravishankar R, Samuels LE, Kaufman MS, et al. Amiodarone-associated hemoptysis. Am J Med Sci. Dec 1998;316(6):390-2. [Medline].

  13. Wyman MG, Wyman RM, Cannom DS, Criley JM. Prevention of primary ventricular fibrillation in acute myocardial infarction with prophylactic lidocaine. Am J Cardiol. Sep 1 2004;94(5):545-51. [Medline].

  14. Joshi S, Raiszadeh F, Pierce W, Steinberg JS. Antiarrhythmic induced electrical storm in Brugada syndrome: a case report. Ann Noninvasive Electrocardiol. Jul 2007;12(3):274-8. [Medline].

  15. Batcher EL, Tang XC, Singh BN, Singh SN, Reda DJ, Hershman JM. Thyroid function abnormalities during amiodarone therapy for persistent atrial fibrillation. Am J Med. Oct 2007;120(10):880-5. [Medline].

  16. Tzivoni D, Banai S, Schuger C, Benhorin J, Keren A, Gottlieb S, et al. Treatment of torsade de pointes with magnesium sulfate. Circulation. Feb 1988;77(2):392-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

antidysrhythmic drug toxicity, antidysrhythmic drug poisoning, antidysrhythmic drug exposure, class I drugs, sodium channel blockers, class II drugs, beta-adrenergic blockers, class III drugs, potassium channel blockers, class IV drugs, calcium channel blockers, antiarrhythmic exposures

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Joshua B Gaither, MD, Chief Resident, Department of Surgery, Section of Emergency Medicine, Yale New Haven Hospital
Joshua B Gaither, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Carin M Van Gelder, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University; Consulting Staff and EMS Physician, SHARP Team, Division of Emergency Medical Services, Section of Emergency Medicine, Yale-New Haven Medical Center
Carin M Van Gelder, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio
Miguel C Fernandez, MD, FAAEM, FACEP, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Michael J Burns, MD, Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center
Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.