Aims Binge drinking induced arrhythmia in apparently healthy individuals is a well known entity in adult literature. Epinephrine surge, ethanol, hypovolaemia and hypothermia are some common causative factors. The common type of arrhythmia seen is atrial fibrillation. The following case report describes a teenager with an undetected cardiac disease presenting with arrhythmia following binge drinking. We aim to increase the awareness among paediatricians about this condition as alcohol consumption is becoming a common problem in adolescence.
Case Report A 14 year old previously healthy girl was brought to the emergency treatment unit in a semi-conscious state following excessive ingestion of alcohol. On admission she was found to be hypothermic (temperature 31.8 Celsius) and hypovolaemic with cold clammy extremities, pulse at 180 bpm and blood pressure at 80/38 mmHg. Her Glasgow coma scale reading was 13/15. No external injuries was present. An urgent ECG recording revealed a tachyarrhythmia compatible with ventricular tachycardia. Investigations revealed a low sodium and potassium levels in blood (134 mmol/L and 3.8 mmol/L respectively) and a partially compensated mild metabolic acidosis. Treatment was started with stabilisation, re-warming and fluid replacement which required two crystalloid boluses. The tachyarrhythmia resolved spontaneously following above management and the repeat ECG revealed sinus rhythm but a short PR interval and delta waves were noted. A diagnosis of Wolff-Parkinson-White syndrome was made which was later confirmed at a Tertiary care centre where this young girl underwent surgical ablation of the aberrant conduction pathway. Since then the patient has remained free of further arrhythmias.
Conclusion The above case report clearly highlights the danger of binge drinking as despite having a potential arrhythmogenic condition since birth the patient did not have an arrhythmia until she was exposed to alcohol. The spontaneous remission of the tachyarrhythmia following correction of hypothermia and hypovolaemia resulting from binge drinking further confirms this. The presentation with a ventricular arrhythmia emphasise the importance of being aware of atypical presentations of a known disease as both alcohol ingestion and WPW syndrome usually present with supra ventricular arrhythmias.