SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Atrial fibrillation is the most common sustained rhythm disorder observed in clinical practice leading to serious clinical consequences such as hemodynamic impairment and ischemic stroke. A few common risk factors are older age, heart failure and smoking. However, drugs and toxins may induce the onset or worsen pre-existing Atrial fibrillation. Our case discusses isopropyl alcohol use inducing renal failure and severe thyrotoxicosis which led to uncontrolled atrial tachycardia CASE PRESENTATION: 59-year-old male presented due to the sensation of his AICD delivering shocks. He presented with history of Systolic Congestive Heart Failure status post AICD placement, Atrial flutter status post ablation, Atrial Fibrillation on Xarelto, Chronic Respiratory Failure on home oxygen. He endorsed the AICD delivered shocks while attempting to climb stairs and a sensation of unsteadiness. On physical exam he became confused, JVD was present with bilateral lower extremity swelling with cellulitis. Vital signs were significant for hypotension 90/53 and tachycardia of 140. Labs revealed leukocytosis 17K, high anion gap metabolic acidosis, elevated BNP 1900k and severe hypocalcemia. He was admitted to ICU for emergent CVVHD and IV antibiotics for cellulitis. EKG revealed atrial fibrillation with rapid ventricular rate. Amiodarone continuous infusion was started but held due to propagating hypotension and Esmolol was attempted. AICD interrogation revealed no shocks being transmitted. The following day labs revealed TSH <0.005 and T4 of 1.67 After CVVHD, mentation improved, the patient admitted to buying methadone off the street and mixing it with rubbing alcohol as well as cough syrup to ingest. CVVHD was discontinued after two days due to marked improvement of renal failure. Although the patient remained in atrial tachycardia for 5 days after presentation eventually controlled with methimazole treatment and Amiodarone. The acute kidney failure and electrolyte abnormalities were likely due to isopropyl ingestion perpetuating severe thyrotoxicosis causing persistent atrial tachycardia which is a unique presentation DISCUSSION: Isopropyl alcohol is a solvent, antiseptic, and disinfectant also known as rubbing alcohol. Isopropyl alcohol metabolizes to acetone which is a central nervous system depressant. The side effects of poisoning are respiratory sedation, hypotension and may induce arrhythmia. CONCLUSIONS: There has not been a case that discusses the effects of this toxin causing thyroxicosis potentiating uncontrolled Atrial Fibrillation. Initially the electrolyte abnormalities and renal failure were suspected to be caused by sepsis from cellulitis or acute tubular necrosis. Toxin induced Atrial fibrillation may play a role in only a minority of the patients nevertheless the ability to recognize potential clinical offenders is significant for early diagnosis and treatment, leading to improved morbidity. Reference #1: Reddy, Taha, Kundumadam, Khanc "Atrial fibrillation and hyperthyroidism: A literature review” Indian Heart J. 2017 Jul-Aug Reference #2: Shetty Tumkur, Bhat, Chacko "An unusual cause of cardiac arrest in a hospitalized patient” J Pharmacol Pharmacother. 2013 Jan-Mar DISCLOSURES: No relevant relationships by Siddharth Bhesania, source=Web Response No relevant relationships by Adnan Raza, source=Web Response No relevant relationships by Jean Singh, source=Web Response