title: Severe central nervous system and cardiovascular toxicity in a pediatric patient after ingestion of an over-the-counter local anesthetic.
abstract: Dibucaine is considered one of the most potent and consequently toxic amide anesthetics available, and despite withdrawal from the US market as a spinal anesthetic, it remains accessible as an over-the-counter preparation in the United States. Dibucaine exposures in children are infrequently encountered, but to date, all reported consequential ingestions have resulted in death. We report the first case of a potentially fatal dibucaine-induced wide-complex arrhythmia in a child who survived her clinical course without sequelae. It is our hope that this report will highlight the toxicity of dibucaine and prompt a review of its over-the-counter status. The rationale and success of a new antidote, 20% lipid emulsion, for the management of local anesthetic toxicity is discussed.
authors.affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, Upstate New York Poison Center, Syracuse, NY 13210, USA. nelsenj@upstate.edu
authors.forename: Jamie
authors.initials: J
authors.lastname: Nelsen
authors.forename: Michael
authors.initials: M
authors.lastname: Holland
authors.forename: Michelle
authors.initials: M
authors.lastname: Dougherty
authors.forename: Jason
authors.initials: J
authors.lastname: Bernad
authors.forename: Christine
authors.initials: C
authors.lastname: Stork
authors.forename: Jeanna
authors.initials: J
authors.lastname: Marraffa
mesh_terms: D000779:Anesthetics, Local / Q000506:poisoning*; D002319:Cardiovascular System / Q000187:drug effects*; D002490:Central Nervous System / Q000187:drug effects*; D003992:Dibucaine / Q000506:poisoning*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007223:Infant
chemical_list: D000779:Anesthetics, Local; D003992:Dibucaine