Prehospital epinephrine overdose in a child resulting in ventricular dysrhythmias and myocardial ischemia.
BACKGROUND
Epinephrine overdoses in children have been associated with supraventricular tachycardia. Myocardial ischemia subsequent to epinephrine overdose has not been reported in pediatric patients.


METHODS
We report a case of ventricular dysrhythmias and myocardial ischemia in a 5-year-old boy who received 10 times the recommended dose of subcutaneous epinephrine. Prehospital providers administered the epinephrine, believing it was part of a "high-dose" epinephrine protocol.


CONCLUSIONS
There is no role for high-dose epinephrine in the treatment of allergic reactions or asthma. Careful epinephrine dosing, using mg/kg and verifying the volume, dilution, and route of administration is essential to prevent epinephrine toxicity.
Davis
C O
CO
Department of Emergency Medicine, University of Rochester, New York 14462, USA. colleen_davis@urmc.rochester.edu
Wax
P M
PM
D000293:Adolescent; D000322:Adrenergic Agonists / Q000506:poisoning* / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy; D002675:Child, Preschool; D002985:Clinical Protocols; D062787:Drug Overdose; D004632:Emergency Medical Services / Q000592:standards; D004837:Epinephrine / Q000506:poisoning* / Q000627:therapeutic use; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy / Q000209:etiology; D007223:Infant; D008297:Male; D008508:Medication Errors; D017202:Myocardial Ischemia / Q000139:chemically induced*; D017180:Tachycardia, Ventricular / Q000139:chemically induced*
D000322:Adrenergic Agonists; D004837:Epinephrine