N-Acetylprocainamide, Torsades de Pointes, and Hemodialysis
Authors: KHIEM P. V. NGUYEN
Journal: Annals of Internal Medicine (1986)

Letters and Corrections1 February 1986N-Acetylprocainamide, Torsades de Pointes, and HemodialysisKHIEM P. V. NGUYEN, M.D., GEORGE THOMSEN, M.D., BING LIEM, D.O., CHARLES D. SWERDLOW, M.D., MICHAEL R. FRANZ, M.D.KHIEM P. V. NGUYEN, M.D.Search for more papers by this author, GEORGE THOMSEN, M.D.Search for more papers by this author, BING LIEM, D.O.Search for more papers by this author, CHARLES D. SWERDLOW, M.D.Search for more papers by this author, MICHAEL R. FRANZ, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-104-2-283_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: N-acetylprocainamide (acecainide; NAPA) is the principal metabolite of procainamide. We report a case of N-acetylprocainamide-induced torsade de pointes that was resistant to overdrive pacing, but that responded dramatically to hemodialysis.A 34-year-old woman with chronic glomerulonephritis had mitral valve replacement. Her admission electrocardiogram showed a QT of 0.35 seconds (QTc, 0.40). The blood urea nitrogen level was 65 mg/mL and the creatinine level was 2.6 mg/dL. On the fourth postoperative day, treatment was begun with procainamide for ventricular bigeminy. The ventricular bigeminy was suppressed at procainamide concentrations ranging from 2.7 to 5.6 µg/ mL for the next...References1. OLSHANSKYMARTINSHUNT BJS. N-acetylprocainamide causing torsades de pointes. Am J Cardiol. 1982;50:1439-41. CrossrefMedlineGoogle Scholar2. HERRETHOMSON JJ. Polymorphic ventricular tachycardia and ventricular fibrillation due to N-acetylprocainamide. Am J Cardiol. 1985;55:227-8. CrossrefMedlineGoogle Scholar3. CHOWPIERGIESBOWSHER MAD. Torsades de pointes induced by N-acetylprocainamide. J Am Coll Cardiol. 1984;4:621-4. CrossrefMedlineGoogle Scholar4. STRATMANNWALTERKENNEDY HKH. Torsades de pointes associated with elevated N-acetylprocainamide levels. Am Heart J. 1985;109:375-7. CrossrefMedlineGoogle Scholar5. GIBSONMATUSIKNELSONBRIGGS TELW. Artificial kidneys and clearance calculations. Clin Pharmacol Ther. 1977;20:720-6. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Stanford University School of Medicine Stanford, CA 94305 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByRole of abnormal repolarization in the mechanism of cardiac arrhythmiaExtracorporeal therapies for acute intoxicationsAntiarrhythmicsInhibition of N-Acetylation of Procainamide and Renal Clearance of N-Acetylprocainamide by Para-Aminobenzoic Acid in HumansCombined High-Efficiency Hemodialysis and Charcoal Hemoperfusion in Severe N-Acetylprocainamide IntoxicationPositive inotropic drugs and drugs used in dysrhythmiasRemoval of Toxic Levels of N-Acetylprocainamide with Continuous Arteriovenous Hemofiltration or Continuous Arteriovenous HemodiafiltrationDOUGLASS T. DOMOTO, M.D., WENDY W. BROWN, M.D., PAULA BRUGGENSMITH, M.D.Hemoperfusion for N-Acetylprocainamide IntoxicationSTEVEN C. BORKAN, M.D. 1 February 1986Volume 104, Issue 2Page: 283-284KeywordsAttentionBlood urea nitrogenCreatinineElectrocardiographyGlomerulonephritisMetabolitesMitral valve replacement Issue Published: 1 February 1986 PDF DownloadLoading ...