CASE REPORT: Postmortem Increase of Flecainide Level in Cardiac Blood

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Published: Journal of Analytical Toxicology, ISSN 0146-4760, Volume 32, Number 6, July/August, pp.451-453

CASE REPORT: Postmortem Increase of Flecainide Level in Cardiac Blood
Kei Yoshitome¹, Satoru Miyaishi¹, Yuji Yamamoto¹, and Hideo Ishizu²
¹Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan and
²Department of Social Work, Faculty of Health and Welfare, Kawasaki University of Medical Welfare, Okayama, Japan

We encountered a case of fatal congestive heart failure that occurred under the influence of flecainide. In this case, an extreme postmortem increase in the flecainide level was identified in cardiac blood. The patient had been administered 400 mg/day of flecainide for seven days before death. Antemortem plasma obtained 13 h before death showed a flecainide concentration of 2.5 mg/L and a pH of 7.4. In comparison, centrifuged supernatants of postmortem right and left cardiac blood contained flecainide concentrations of 13.8 and 44.2 mg/L, respectively, with pH of 5.5 in both samples. This increase in blood flecainide concentration was attributed to postmortem redistribution, as about 18 h had passed between the last intake of flecainide and death.

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