title: Phentolamine reversal of epinephrine-induced digital vasospasm. How to save an ischemic finger.
abstract: A 17-year-old girl accidently injected her thumb with an adult autoinjector epinephrine syringe, resulting in rapid digital ischemia. Local infiltration of 0.5% phentolamine mesylate injected at the puncture site immediately resolved the ischemia and resulted in no long-term sequelae. Similar cases of epinephrine-induced digital ischemia are reviewed herein, revealing phentolamine to be the drug of choice for reversal of this type of ischemia. Alternative attempts to restore blood flow included warm water immersion, amyl nitrite inhalations, metacarpal nerve block, and application of topical nitroglycerin paste; each was found to be ineffective. We conclude that digital ischemia secondary to accidental injection of epinephrine can be quickly and safely reversed with the use of 0.5% phentolamine locally infiltrated in the region of accidental injection.
authors.affiliation: Department of Family and Community Medicine, Lancaster General Hospital.
authors.forename: J W
authors.initials: JW
authors.lastname: Hinterberger
authors.forename: H E
authors.initials: HE
authors.lastname: Kintzi
mesh_terms: D000059:Accidents; D000293:Adolescent; D004837:Epinephrine / Q000009:adverse effects*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000139:chemically induced / Q000188:drug therapy*; D016602:Needlestick Injuries / Q000209:etiology; D010646:Phentolamine / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D004837:Epinephrine; D010646:Phentolamine