Myocardial Dysfunction After Epinephrine Treatment of Presumed Insect Venom Allergy in a Marathon Runner

Epinephrine in Anaphylaxis: Higher Risk of Cardiovascular Complications and Overdose After Administration of Intravenous Bolus Epinephrine Compared with Intramuscular Epinephrine

“…Although numerous case reports have established the link between IV bolus epinephrine and CV complications, and rare cases of CV complications with IM epinephrine have been published, our results provide a denominator and thus allow for an estimate of the prevalence of overdose and adverse CV events based on the total number of doses administered. 4,[7][8][9][10][11][12] All of the CV complications associated with IV bolus epinephrine also were associated with an overdose. Based on published guidelines, IV bolus epinephrine should only be administered when a patient continues to be profoundly hypotensive despite multiple doses of IM epinephrine and IV fluid resuscitation, or has experienced cardiorespiratory arrest.…”

“…Other case reports have demonstrated this mechanism of error as well. 10,11 This patient was in imminent danger of airway obstruction. Her severe airway edema had recurred after administration of IM epinephrine, and an IV infusion was not rapidly available.…”

“…7 Although adverse cardiovascular (CV) complications are associated most frequently with intravenous (IV) epinephrine and occasionally with other routes of delivery, data are limited to case reports, and there are no studies that directly compared the safety of various methods of epinephrine administration. 4,[7][8][9][10][11][12] We sought to determine if rates of CV adverse events and epinephrine overdoses associated with anaphylaxis management differ among various routes of epinephrine administration among patients who present to the ED with anaphylaxis.…”

Frequency of cardiotoxicity following intramuscular administration of epinephrine in emergency department patients with anaphylaxis

“…Other side effects described included decreased ejection fraction, diagnosis of cardiomyopathy, and coronary artery thrombus that was diagnosed on cardiac catheterization 19–22 . The other case reports described 34 patients in total who received an intravenous bolus dose of epinephrine inadvertently, or an inappropriately high IM dose 23–52 . This led to a wide array of side effects including arrhythmias, cardiomyopathy, thrombus, and cardiac arrest.…”