Acute myocardial ischemia following accidental intravenous administration of epinephrine in high concentration.
Inadvertent and accidental epinephrine overdose might result in potentially lethal complications. We present a case of acute epinephrine toxicity resulting in acute myocardial ischemia in a young boy with combined variable immunodeficiency syndrome who developed severe allergic reaction to intravenous immunoglobulin, and was subsequently given epinephrine by mistake intravenously rather than subcutaneously. He developed significant ischemic changes in standard 12-lead electrocardiogram, transiently raised cardiac enzymes, reduced left ventricular systolic function, pulmonary edema and pulmonary hemorrhage. It is suggested that special precautionary measures should be taken regarding the dose and the route while administering epinephrine to avoid mishaps.
Arfi
Amin M
AM
Section of Pediatric Cardiology and Pharmacy Service, King Faisal Special Hospital and Research Center, Saudi Arabia. ped_cardiologist@doctor.com
Kouatli
Amjad
A
Al-Ata
Jameel
J
Arif
Hussain
H
Syed
Seema
S
D000208:Acute Disease; D000293:Adolescent; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D004837:Epinephrine / Q000009:adverse effects* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy / Q000209:etiology; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008297:Male; D008508:Medication Errors; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D018570:Risk Assessment; D016511:Severe Combined Immunodeficiency / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D004837:Epinephrine