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Case report
Intravenous epinephrine overdose in prehospital management of suspected anaphylaxis
  1. Jack Callum,
  2. Myles Rivlin and
  3. Patrick Carroll
  1. General Medicine, Metro North Hospital and Health Service, Redcliffe, Queensland, Australia
  1. Correspondence to Dr Jack Callum; jacktcallum{at}gmail.com

Abstract

A 65-year-old woman called paramedics for stridor and neck swelling following an insect bite with a possible anaphylactic reaction. On arrival paramedics administered intramuscular epinephrine without any observed improvement in stridor. Paramedics then prepared 5 mg of 1:1000 epinephrine for nebulised administration, which was inadvertently given intravenously. The patient developed tachycardia, anxiety and a severe headache, with biochemical evidence of cardiac necrosis without any haemodynamic compromise. The patient recovered over the next 24 hours and no long-term sequelae were identified on CT coronary angiogram, electrocardiography (ECG) echocardiography or invasive angiography. This case highlights the risk of cardiac ischaemia during epinephrine administration and the importance of protocols to ensure appropriate dosing. This case also raises questions regarding appropriate management of epinephrine overdose and shines a light on the absence of guidelines on the prevention of complications from epinephrine administration.

  • arrhythmias
  • Ischaemic heart disease
  • prehospital
  • safety
  • toxicology
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Footnotes

  • Contributors JC, MR, PC planned this case report, took the history and examined the patient. JC and MR conducted the literature review and wrote the case report with PC proofing and editing the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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