• Nisha Donthi, Tejasri Chandrabhatla, Leonard Genovese, and Christopher deFilippi.
• Inova Fairfax Medical Campus, Falls Church, Virginia, USA nisha.donthi@gmail.com.
• BMJ Case Rep. 2020 Dec 13; 13 (12).

AbstractA 63-year-old woman on flecainide, furosemide, and triamterene-hydrochlorothiazide 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.© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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