Lacosamide Overdose: A Case of QRS Prolongation and Seizure |
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| Affiliation: | 1. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado;2. Department of Emergency Medicine, University of Colorado at Denver-Anschutz Medical Campus, Aurora, Colorado;3. Department of Pediatrics, Children''s Hospital Colorado, Aurora, Colorado;1. Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan;2. Department of Medicine, Mackay Medical College, New Taipei City, Taiwan;3. Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan;1. Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil;2. AIDS Division, Carlos Tortelly Municipal Hospital, Ministry of Health, Niterói, Rio de Janeiro, Brazil;3. International Foundation for Dermatology, London, United Kingdom;1. Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Texas Children''s Hospital, Houston, Texas;2. Baylor College of Medicine, Baylor University, Houston, Texas;3. Division of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children''s Hospital, Houston, Texas;1. Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI;2. Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA;3. Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD;4. Department of Emergency Medicine, Children''s Hospital Colorado, Aurora, CO;5. Department of Pediatrics, Cincinnati Children''s Hospital, Cincinnati, OH;7. Department of Emergency Medicine, University of Michigan, Flint, MI;11. Department of Pediatrics, New York Presbyterian-Morgan Stanley Children''s Hospital, New York, NY;12. Department of Pediatrics, Ann and Robert H. Lurie Children''s Hospital, Chicago, IL;8. Department of Pediatrics, University of Utah; Salt Lake City, UT |
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| Abstract: | BackgroundLacosamide is a third-generation antiepileptic drug. Its likely mechanism of action is via neuronal sodium channel blockade, via a unique manner compared with other antiepileptic drugs that block sodium channels. A paucity of information exists regarding lacosamide overdosage. Lacosamide overdosage is thought to cause QRS prolongation and seizures, due to its effect of sodium channel blockade. The potential efficacy of sodium bicarbonate to reverse the effects of lacosamide has not been well studied. Furthermore, prior reports of lacosamide toxicity have occurred in the setting of concomitant polypharmacy. Thus, the isolated toxic effects of the drug have not been well elucidated.Case ReportWe report a case of a suspected, single-ingestion overdose on lacosamide. The patient developed signs of cardiotoxicity and seizure.Why Should an Emergency Physician Be Aware of This?After lacosamide overdosage, the emergency physician must be capable of acute management of subsequent lacosamide toxicity. Understanding the mechanisms of action causing toxicity due to this drug can help the clinician to anticipate the interventions that may be needed or useful to treat this potentially toxic ingestion. |
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| Keywords: | lacosamide sodium channel blockade seizure bicarbonate |
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