Electrocardiographic Changes After Overdose of Epinephrine in a Patient With Anaphylaxis

Jiang, Chunyan; Li, Hongwei

doi:10.1001/jamainternmed.2019.1230

Cited by 8 publications

(9 citation statements)

References 9 publications

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“…This implies a general lack of awareness about the gaps in the initial treatment of anaphylaxis among many Chinese healthcare professionals. 9 Our findings call for concerted efforts to remedify the current situation and to promote the safety of Chinese patients with anaphylaxis.…”

Section: Patient Characteristics Are Summarized Inmentioning

confidence: 85%

Gaps between actual initial treatment of anaphylaxis in China and international guidelines: A review and analysis of 819 reported cases

Jiang

Wang

et al. 2019

Allergy

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Section: Patient Characteristics Are Summarized Inmentioning

confidence: 85%

Gaps between actual initial treatment of anaphylaxis in China and international guidelines: A review and analysis of 819 reported cases

Jiang

Wang

et al. 2019

Allergy

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“…First, ECG alterations and troponin elevation in the setting of anaphylaxis should be carefully evaluated: possible differential diagnoses are represented by Kounis syndrome1—also called allergic angina—and ATAK complex (adrenaline, takotsubo, anaphylaxis, Kounis syndrome) 2. However, in the present case, given the absence of chest pain and of echocardiographic abnormalities, ECG modifications have been attributed to the effect of high dose intravenous epinephrine administration 3. Although in the absence of risk factors for coronary artery disease and chest pain, these alterations led to several troponin determinations until normalisation, and to echocardiography (which resulted normal) (figure 1).…”

Section: Outcome and Follow-upmentioning

confidence: 79%

Electrocardiographic alterations and raised procalcitonin levels during anaphylactic shock

et al. 2020

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Anaphylaxis represents a systemic disease occurring after the exposure to an allergen. Drugs for the treatment of anaphylactic reactions (ie, corticosteroids and adrenalin) could induce autonomic alterations, such as tachycardia, hyperthermia, tachypnoea and leucocytosis. We describe the case of a 52-year-old woman presenting with a severe allergic reaction after the ingestion of amoxicillin-clavulanate. The occurrence of ECG alterations, laboratory abnormalities and procalcitonin (PCT) elevation will be discussed with particular emphasis on the possible misleading role of PCT during anaphylactic shock.

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“… 4 High levels of epinephrine can cause adverse cardiovascular reactions, such as myocardial ischemia, dysrhythmias, and acute heart failure. 2 , 5 , 6 Here, iatrogenic epinephrine toxicity was the suspected cause for myocardial stunning.…”

Section: Discussionmentioning

confidence: 99%

“…Computational modeling suggests that toxic concentrations of catecholamines in TTS can prolong action potential duration due to increases in late I Na and decreases I to , which may increase the risk of ventricular arrhythmias. 2 , 7 …”

Section: Discussionmentioning

confidence: 99%

Myocardial stunning secondary to erroneous administration of intravenous epinephrine

Pathangey

Moudgal

Lee

et al. 2023

SAGE Open Medical Case Reports

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Epinephrine is a commonly used medication for emergent conditions, such as anaphylaxis, respiratory distress, and shock. However, its versatility can also lead to iatrogenic errors in dosages, concentrations, and routes of administration. In this case, a 47-year-old female experiencing anaphylaxis received an intravenous dose of 0.3 mg (1:1000) epinephrine formulated for intramuscular injection, resulting in cardiac arrest and acute heart failure due to myocardial stunning, as diagnosed by echocardiography. Management included invasive ventilation and hemodynamic support until cardiac function recovered. This case highlights the potential dangers of epinephrine overdose, and to our knowledge, is the first reported case of iatrogenic epinephrine-induced Takotsubo cardiomyopathy in a rural area. In addition, we review the literature on iatrogenic epinephrine toxicity-associated cardiomyopathy and the epidemiology of epinephrine errors. Safety measures must be considered for improving communication in emergencies, increasing awareness via training, and changing epinephrine’s antiquated packaging design.

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Electrocardiographic Changes After Overdose of Epinephrine in a Patient With Anaphylaxis

Cited by 8 publications

References 9 publications

Gaps between actual initial treatment of anaphylaxis in China and international guidelines: A review and analysis of 819 reported cases

Gaps between actual initial treatment of anaphylaxis in China and international guidelines: A review and analysis of 819 reported cases

Electrocardiographic alterations and raised procalcitonin levels during anaphylactic shock

Myocardial stunning secondary to erroneous administration of intravenous epinephrine

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