3. A Fatal Case of Poisoning by Lidocaine Overdosage – Analysis of Lidocaine in Formalin-Fixed Tissues

Abstract

The death of a 76-year-old man with heart disease as a result of the injection of an excessive dose of lidocaine is presented. The patient was given 5 ml of 10% lidocaine hydrochloride (500 mg) intravenously instead of 2.5 ml of 2% lidocaine hydrochloride (50mg) in order to treat repeated paroxysmal ventricular arrhythmia. Immediately following the injection the patient had tonic clonic seizures and complete cardiopulmonary arrest followed. Although resuscitation attempts once successfully restarted his pulse and spontaneous respiration, the patient died on the eighth day after the injection. Toxicological examinations were carried out on the tissues obtained at the time of autopsy and which had been fixed in formalin solution for 40 days, and lidocaine was detected in each tissue examined. The concentrations were (ng/g or ml): parietal lobe, 308.0; occipital lobe, 208.7; temporal lobe, 318.0; frontal lobe, 223.2; cerebellum 200.9; pons 285.7; liver, 109.5; kidney 52.2; skeletal muscle 127.0; and formalin solution 8.4. In an experiment on rats we determined the concentration changes of lidocaine in formalin fixed tissues. The concentrations of lidocaine in these tissues significantly decreased to 1/3-1/4 from the original. This data shows that the cause of death was poisoning by lidocaine overdose.

Suicide due to oral ingestion of lidocaine: a case report and review of the literature

“…Various several accidental fatalities and suicides following intravenous injection of lidocaine have been reported [5][6][7][8][9][10][11][12] while, rare are the fatal cases realized after oral ingestion of lidocaine [8,[13][14][15][16].…”

Lidocaine intoxication in axillary block: similar pharmaceutical form, different concentration

“…Kudo et al [7] presented a 76-year-old patient with known paroxysmal ventricular dysrhytmia who was injected 5 ml 10% lidocaine (599 mg) instead of 2.5 ml 2% lidocaine (50 mg) for the treatment of his dysrhytmia. They reported tonic-clonic convulsions immediately after high doses of lidocaine injection, then cardiac arrest developed.…”

A Lady with Confusion and Seizure after Ingestion of Lidocaine for Dyspepsia

“…Asystole has been reported in patients who received unintentional intravenous injections of 800-1000 mg of lidocaine. [2][3][4][5] Seizure occurred prior to cardiac arrest in most patients. Thus, CNS toxicity provides a warning sign to cardiac toxicity.…”