Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-14T08:08:42.669Z Has data issue: false hasContentIssue false
  • English
  • Français

Accidental injection of epinephrine by a child: a unique approach to treatment

Published online by Cambridge University Press:  21 May 2015

Catharine Sellens  and
Laurie Morrison
Catharine Sellens*
Affiliation:
University of Toronto, and Sunnybrook and Women’s College Health Science Centre, Toronto, Ont
Laurie Morrison*
Affiliation:
University of Toronto, and Sunnybrook and Women’s College Health Science Centre, Toronto, Ont
*
PHC.research@utoronto.ca
PHC.research@utoronto.ca

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

A 9-year-old girl accidentally injected her right thumb with an adult dose of epinephrine through an auto-injector syringe, delivering 0.3 mg of 1:1000 epinephrine. This injection caused immediate ischemic changes in the digit. This is the first reported case of accidental self injection by a child of an adult dose of epinephrine and its successful treatment with low-dose phentolamine simultaneously infiltrated directly into the puncture area and along the course of the digital artery. The use of phentolamine as a specific competitive alpha-adrenergic antagonist to epinephrine has been well documented in adults and animal models. This report compares the management of a pediatric case to that of all reported adult cases of accidental subcutaneous epinephrine injections. This case suggests a pattern of infiltration with low-dose phentolamine that may be the most effective form of treatment for this condition in a patient of any age.

Type
Pediatrics • Pédiatrie
Information
Canadian Journal of Emergency Medicine , Volume 1 , Issue 1 , April 1999 , pp. 34 - 36
Copyright
Copyright © Canadian Association of Emergency Physicians 1999

References

1.Maguire, WM, Reisdorff, MD.Epinephrine-induced vasospasm reversed by phentolamine digital block. Am J Emerg Med 1990;8:46–7.CrossRefGoogle ScholarPubMed
2.Hinterberger, JW, Kintzi, HE.Phentolamine reversal of epinephrine-induced digital vasospasm. Arch Fam Med 1994;3:193–5.CrossRefGoogle ScholarPubMed
3.Deshmukh, N, Tolland, JT.Treatment of accidental epinephrine injection in a finger [letter]. J Emerg Med 1989;7(4):408.CrossRefGoogle ScholarPubMed
4.Roberts, JR, Krisanda, TJ.Accidental intra-arterial injection of epinephrine treated with phentolamine. Ann Emerg Med 1989;18:424–5.CrossRefGoogle ScholarPubMed
5.McCauley, WA, Gerace, RV, Scilley, C.Treatment of accidental digital injection of epinephrine. Ann Emerg Med 1991;20:665–8.CrossRefGoogle ScholarPubMed
6.Mol, CJ, Gaver, J.A 39-year-old nurse with accidental discharge of an epinephrine autoinjector into the left index finger. J Emerg Nurs 1992;18:306–9.Google ScholarPubMed
7.Weiner, N.Alpha-adrenergic blocking agents. In: Gilman, AG, Goodman, LS, Rall, TW, Hardman, JG, Limbird, LE, Molinoff, PB, et al, editors. The pharmacologic basis of therapeutics, 9th ed. New York: Macmillan Publishing Co.; 1996. p. 221–43.Google Scholar
8.Johnson, HA.Infiltration with epinephrine and local anesthetic mixture in the hand. JAMA 1967;200:990–1.CrossRefGoogle ScholarPubMed
9.Aycock, BG, Hawtof, DB, Moody, SB.Treatment of peripheral ischemia secondary to lidocaine containing epinephrine. Ann Plast Surg 1989;23:27–30.Google Scholar
10.Richards, DA, Woodings, EP, Prichard, BNC.Circulatory and alpha-adrenoceptor blocking effects of phentolamine. Br J Clin Pharmacol 1978;5:507–13.CrossRefGoogle ScholarPubMed
11.Coffman, JD, Cohen, RA.Intra-arterial vasodilator agents to reverse human finger vasoconstriction. Clin Pharmacol Ther 1987;41:574–9.Google Scholar
12.Zucker, G.Use of phentolamine to prevent necrosis due to levarterenol. JAMA 1957;163:1477–9.CrossRefGoogle ScholarPubMed
13.Burkhart, KK.The reversal of the ischemic effects of epinephrine on a finger with local injections of phentolamine [letter; comment]. J Emerg Med 1992;10(4):496. Comment in: J Emerg Med 1991;9(5):323–4.CrossRefGoogle ScholarPubMed
14.Markovchick, V, Burkhart, KK.The reversal of the ischemic effects of epinephrine on a finger with local injections of phentolamine [see comment]. J Emerg Med 1991;9(5):323–4. Comment in: J Emerg Med 1992;10(4):496.CrossRefGoogle ScholarPubMed