Severe central nervous system and cardiovascular toxicity in a pediatric patient after ingestion of an over-the-counter local anesthetic.
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.
Nelsen
Jamie
J
Department of Emergency Medicine, SUNY Upstate Medical University, Upstate New York Poison Center, Syracuse, NY 13210, USA. nelsenj@upstate.edu
Holland
Michael
M
Dougherty
Michelle
M
Bernad
Jason
J
Stork
Christine
C
Marraffa
Jeanna
J
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
D000779:Anesthetics, Local; D003992:Dibucaine