It is a fine line with flecainide: A case of flecainide toxicity in a pediatric patient

Flecainide is a class IC antiarrhythmic used in the treatment of supraventricular and ventricular tachyarrhythmias in the pediatric population. It has a narrow therapeutic index that requires careful dosing and monitoring of levels, as well as education on preparation and administration. Many different factors alter the bioavailability of this medication, and special consideration must be taken among pediatric patients. Clinical signs of toxicity include lethargy, bradycardia, altered mental status, and ventricular arrhythmias. Management of flecainide toxicity involves administering sodium bicarbonate as well as lipid emulsion therapy. We present the case of a child found to have flecainide toxicity and discuss management strategies.