Adrenaline overdose in pediatric anaphylaxis: a case report.

BACKGROUND: Adrenaline is the standard treatment for anaphylaxis but appropriate administration remains challenging, and iatrogenic overdose is easily overlooked. Despite the established importance of pediatric blood pressure measurement, its use remains inconsistent in clinical practice. CASE PRESENTATION: We report a case of adrenaline overdose in a 9-year-old white boy with anaphylaxis, where signs of adrenaline overdose were indistinguishable from progressive shock until blood pressure measurement was taken. CONCLUSIONS: The consequences of under-dosing adrenaline in anaphylaxis are well-recognized, but the converse is less so. Blood pressure measurement should be a routine part of pediatric assessment as it is key to differentiating adrenaline overdose from anaphylactic shock.

Administración accidental de dosis tóxicas de adrenalina intravenosa a un lactante de 5 meses / Accidental administration of toxic doses of intravenous adrenaline to a 5-month old infant

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Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution.

Epinephrine is indicated for various medical emergencies, including cardiac arrest and anaphylaxis, but the dose and route of administration are different for each indication. For anaphylaxis, it is given intramuscularly at a low dose, whereas for cardiac arrest a higher dose is required intravenously. We encountered a patient with suspected anaphylaxis who developed transient severe systolic dysfunction because of inappropriately received cardiac arrest dose, ie, larger dose given as an intravenous push. Three additional patients who experienced potentially lethal cardiac complications after receiving inappropriately higher doses intravenously were also identified. These iatrogenic errors resulted from underlying confusion by physicians about proper dosing of epinephrine for anaphylaxis. The risk of error was amplified by the need for rapid decision making in critically ill anaphylactic patients. An e-mail survey of local hospitals in southeast Michigan revealed that 6 of 7 hospitals did not stock prefilled intramuscular dose syringes for emergency use in anaphylaxis. At our institution, we have introduced prefilled and appropriately labeled intramuscularly dosed epinephrine syringes in crash carts, which are easily distinguished from intravenously dosed epinephrine syringes. In this Concepts article, we describe the clinical problem of inadvertent epinephrine overdose and propose a potential solution. Epinephrine must be clearly packaged and labeled to avoid inappropriate usage and unnecessary, potentially lethal complications in patients with anaphylaxis.

Electromagnetic immunity of infusion pumps to GSM mobile phones: a systematic review.

Electromagnetic interference with life-sustaining medical care devices has been reported by various groups. Previous studies have demonstrated that volumetric and syringe pumps are susceptible to false alarm buzzing and blocking, when exposed to various electromagnetic sources. The risk of electromagnetic interference depends on several factors such as the phone-emitted power, distance and carrier frequency, phone model and antenna type. The main recommendations and the relevant harmonized standard are also reported and discussed. >From the data available in literature emerges that, for distances lower than 1 m there is a non negligible risk of electromagnetic interferences, although significant differences exists in the reported minimum distances. Interference effects clinically relevant for the patients are rare. No permanent damage to the pumps has been ever reported, although in several cases intervention of personnel is required to resume normal operation.

Epinephrine overdose-associated hypokalemia and rhabdomyolysis in a newborn.

Epinephrine overdose induces many negative complications in adults because of its alpha- and beta-adrenoreceptor activity. However, complications in newborns or children are rarely described. A 4-day-old, 2004-g female newborn was inadvertently given epinephrine at 100 times the usual dose; she developed hypokalemia and rhabdomyolysis. A nurse erroneously administered 2 mg of epinephrine 1:1000 (1 mg/ml) into a peripheral intravenous line in the patient's right leg. Her potassium level decreased to 2.2 mEq/L. An infusion of potassium chloride 2 mEq/kg/day over 80 hours was required to correct the hypokalemia. Rhabdomyolysis was diagnosed and confirmed from laboratory results of an elevated creatine kinase level (peak 4124 U/L), with 100% creatine kinase-MM isoenzymes. No obvious long-term sequelae were observed. Effective ventilation, proper hydration, electrolyte maintenance, and early detection were assumed responsible for the positive outcome. Medication errors are common with pediatric inpatients, and efforts to reduce them are needed.

Accidental injection of epinephrine from an autoinjector: invasive treatment not always required.

BACKGROUND: Individual case reports of accidental injection with epinephrine appear in the literature and seem to represent the worst case scenarios. We present a case series of 28 exposures to epinephrine via autoinjector. METHOD: All accidental parenteral injections of epinephrine by autoinjector reported to two regional poison information centers over a 2-year period were included. RESULTS: Injection sites included digits (23 cases), palm (4 cases), and thigh (1 case). Symptoms included swelling, pallor, pain, and erythema. Four patients reported no effect, and 9 required no treatment. Ten patients obtained relief with warm soaks, 1 patient had massage only, and 2 patients were lost to follow-up. Fourteen were examined in the emergency department, and 14 were treated at home. CONCLUSION: Although some injection injuries must be treated in an emergency facility, many can be treated at home. Immediate referral to a health care facility is not needed in all cases and at times is unwarranted.

Role of activation of the sympathoadrenal system in the realization of immune reactions during acute poisoning with organophosphorus compounds.

Experiments on Wistar rats showed that acute poisoning with organophosphorus compound dimethyldichlorovinylphosphate (0.2 and 0.8 LD50) was accompanied by suppression of the major immune reactions. Increasing the concentration of epinephrine and norepinephrine in the plasma produced less pronounced opposite effects, except for the influence on natural killer activity.

Prehospital epinephrine overdose in a child resulting in ventricular dysrhythmias and myocardial ischemia.

INTRODUCTION: Epinephrine overdoses in children have been associated with supraventricular tachycardia. Myocardial ischemia subsequent to epinephrine overdose has not been reported in pediatric patients. CASE REPORT: We report a case of ventricular dysrhythmias and myocardial ischemia in a 5-year-old boy who received 10 times the recommended dose of subcutaneous epinephrine. Prehospital providers administered the epinephrine, believing it was part of a "high-dose" epinephrine protocol. DISCUSSION: There is no role for high-dose epinephrine in the treatment of allergic reactions or asthma. Careful epinephrine dosing, using mg/kg and verifying the volume, dilution, and route of administration is essential to prevent epinephrine toxicity.

Acute renal failure, anterior myocardial infarction, and atrial fibrillation complicating epinephrine abuse.

After injecting the solution extracted from a Primatene Mist inhaler, a patient experienced epinephrine overdose that resulted in an acute myocardial infarction and acute renal failure. The exact amount of epinephrine injected was unknown, but was thought to be between 82.5 and 124 mg, more than 25 times higher than the amount normally administered. Health care providers should be aware of this readily available source of epinephrine and the potential adverse effects associated with its inappropriate use.

[Changes in the lipid spectrum of the lungs in poisoning by nitrogen oxides or adrenaline]. / Izmeneniia v lipidnom spektre legkikh pri intoksikatsii oksidami azota ili adrenalinom.

The content of lipids and fatty acids was measured in lung tissue of intact rats and animals with lung edema caused by nitrogen oxide or adrenaline. Lung edema was found to involve disagreement between the phospholipid and fatty acid spectra and to increase the permeability of membranes. The toxic and adrenaline-induced edemas were found identical as regards the type of changes in the ratio of fractions of neutral lipids, phospholipids, and fatty acid spectrum, that is, these shifts represent a nonspecific reaction of lung tissue to aggression.

Accidental intravenous administration of 50 mg of racemic adrenaline in a 2-year-old boy.

A 2-year-old boy received, by mistake, 50 mg racemic adrenaline intravenously, equivalent to 1.8 mg kg-1 of L-adrenaline. The blood pressure increased to 160/105 mmHg, the heart rate to 160 beats min-1, and pulmonary oedema developed over the next 2 h. He was treated with nitroprusside, nitroglycerin and digitoxin, and was intubated and ventilated. After 3 h a hypotensive phase occurred which required infusions of very high concentrations of catecholamines for 72 h. Renal failure required renal transplantation after which the child made an uneventful recovery.

[Pulmonary edema after intravenous injection of eyedrops containing adrenaline]. / Lungeødem efter intravenøs injektion af adrenalinholdige øjendråber.

A case of adrenaline overdose in a 27 year old male drug addict is reported. Following accidental injection of 20 mg adrenaline he developed pulmonary oedema and severe metabolic acidosis, which responded well to symptomatic treatment.