Adrenaline toxicity following accidental administration of the 1:1000 solution during dental procedures: Four case reports.
Four patients aged between 35 and 50 years attended the out patients department of a dental hospital for tooth extraction. Following administration of, what was thought to be the local anesthetic, Lignocaine, to the gum and sub mucosa, they all collapsed. What had, in fact, been injected was 1:1000 adrenaline. We would like to report the symptoms, signs and investigation findings that followed. Significantly elevated Troponin T, CPK (total), CPK (MB) and ECG changes were seen. Electromyography and Nerve Conduction Studies showed a myopathic pattern and reduction in motor and sensory conduction respectively. These patients were followed up for a period of five years. Long term effects such as tremor, muscle weakness, easy fatigability and shortness of breath on exertion, which is not reported in the literature, were reported by all patients.
Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka. dineshmgfdo@yahoo.com
Dinesh M G
DM
Fernando
K M P L
KM
Dayaratne
D000328:Adult; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D004417:Dyspnea / Q000139:chemically induced; D004562:Electrocardiography; D004576:Electromyography; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced; D009431:Neural Conduction; D013566:Sympathomimetics / Q000008:administration & dosage / Q000009:adverse effects*; D014081:Tooth Extraction; D014202:Tremor / Q000139:chemically induced; D020107:Troponin T / Q000097:blood
D013566:Sympathomimetics; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D004837:Epinephrine