Severe Reaction to Accidental Subcutaneous Administration of Large Doses of Epinephrine

Abstract

CCIDENTAL drug overdosage, a 1 ways A troublesome, is perhaps never so dramatic as when the drug is epinephrine. The case report and discussion to follow are concerned with the accidental subcutaneous injection of about 10 ml. of a 1:2OOO solution of epinephrine (5 mg.) and its degradation and urinary excretion. REPORT OF A CASEA 41-year-old obese and mentally-retarded woman with a basal-cell nevus syndrome was admitted to the University of Virginia Hospital for excision of numerous basal-cell carcinomas, with split thickness skin grafts to follow. She gave a history of multiple surgical procedures over the preceding 10 years, including amputation of the right forearm for an invasive basal-cell carcinoma, bilateral oophorectomy for multinodular ovarian fibromas, bilateral subtotal thyroidectomy for follicular adenoma, and multiple excisions of basal-cell carcinomas of the lower abdomen and sacral region.Admission temperature was 36.6" C. (97" F.) , pulse 84, respirations 20, blood pressure 130/110, and hematocrit 41 percent. Except for right lenticular opacity and numerous basal-cell carcinomas covering the face and trunk, the admission examination was unremarkable.On the morning of surgical operation, she was premedicated intramuscularly with 10 mg. of morphine sulfate and 0.4 mg. of scopolamine hydrobromide. On arrival in the

Optimal Concentration of Epinephrine for Vasoconstriction in Ear Surgery

“…Carter hypothesized that exogenous epinephrine may trigger endogenous catecholamines by demonstrating that excreted epinephrine metabolites doubled that expected from a 5‐mg subcutaneous injection. 6 Epinephrine is a potent adrenergic stimulator with sensitive beta‐adrenergic receptors that cause increased heart rate, cardiac output, and myocardial oxygen consumption. Overstimulation may lead to cardiac arrhythmia.…”

“…In conjunction with the beta‐adrenergic effects, hypertension develops. 6 Reflex bradycardia can develop by stimulation of carotid baroreceptors by severe hypertension. 7 Pulmonary edema develops secondary to epinephrine causing increased peripheral vascular resistance and tachycardia leading to decreased diastolic filling time, cardiac failure, and subsequent increased pulmonary circulation pressure.…”

Update on the usage and safety of epinephrine auto-injectors, 2017

“…For decades, there have been reports on epinephrine administration resulting in severe, and sometimes fatal, CV complications 11–13. Epinephrine increases cardiac output through action on the β 1 -adrenergic receptors in the heart 2.…”

“…Many parents have reservations about potentially using an EAI to administer epinephrine to their children due to concerns over injury, incorrect use, and poor outcomes 10. Prevalent safety concerns regarding the use of EAIs include cardiovascular (CV) complications,11–13 accidental injections,14–16 laceration injuries,17,18 and the use of expired EAIs 19. The present literature review provides an overview of anaphylaxis and discusses the safety concerns, highlighting the recent developments on their frequency, severity, and prevention.…”

Atypical Stress Induced Cardiomyopathy During Endoscopic Sinus Surgery With Septoplasty in an Elderly Male Patient

“…Thirdly, the possibility that epinephrine caused hypersensitization in the body cannot be ruled out. Carter et al 10) measured the discharged epinephrine and the metabolites after an epinephrine injection and reported that the detected amount was 2 times more than the expected value, which can lead to cardiovascular crisis, such as arrhythmia and cardiac arrest. They mentioned the possibility of endogenous epinephrine hypersensitization by the externally injected epinephrine.…”