Title
Author
DOI
Article Type
Special Issue
Volume
Issue
Accidental self-injection of intravenous epinephrine by healthcare personnel
1Department of Emergency Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
DOI: 10.22514/sv.2021.033 Vol.17,Issue 4,July 2021 pp.212-216
Submitted: 31 December 2020 Accepted: 22 January 2021
Published: 08 July 2021
*Corresponding Author(s): Heebum Yang E-mail: heebeom@gmail.com
Epinephrine is a key drug used in resuscitation, including advanced life support situations. A 28-year-old nurse inadvertently injected herself with an ampule of epinephrine and was brought to the emergency department. The injection caused a drop in blood pressure, pulmonary edema, and cardiac enzyme elevation. Upon further evaluation, echocardiography revealed left ventricular wall motion abnormality with reduced ejection fraction. The patient was diagnosed with stress-induced cardiomyopathy (SCMP) and was treated appropriately. After a short stay in the intensive care unit as the vital signs were affected, the patient was transferred to the ward on the second day of hospitalization and was well enough to be discharged on the fifth day. The treatment of SCMP induced by epinephrine is largely conservative with a symptomatic approach. In most cases, the outcome is favorable. Inappropriate drug use, accidental or otherwise, can pose a great risk. More stringent caution should be practiced by medical staff in handling medication to prevent serious medication-related accidents.
Epinephrine; Overdose; Health personnel; Self-administration
Hyunseung Koh,Duk Ho Kim,Jinseong Kim,Heebum Yang. Accidental self-injection of intravenous epinephrine by healthcare personnel. Signa Vitae. 2021. 17(4);212-216.
[1] Spina R, Song N, Kathir K, Muller DWM, Baron D. Takotsubo cardiomyopathy following unintentionally large subcutaneous adrenaline injection: a case report. European Heart Journal Case Reports. 2020; 2: yty043.
[2] Brian HR, Brian G. Allergy and anaphylaxis. In: Tintinalli J, Ma O, Yealy DM, et al., (eds.). Tintinalli’s emergency medicine: a comprehensive study guide (pp. 68-73). 9th edn. New York: McGraw-Hill Education. 2020.
[3] Härle T, Kronberg K, Nef H, Möllmann H, Elsässer A. Inverted Takot-subo cardiomyopathy following accidental intravenous administration of epinephrine in a young woman. Clinical Research in Cardiology. 2011; 100: 471-473.
[4] Khoueiry G, Abi Rafeh N, Azab B, Markman E, Waked A, AbouRjaili G, et al. Reverse Takotsubo cardiomyopathy in the setting of anaphylaxis treated with high-dose intravenous epinephrine. Journal of Emergency Medicine. 2013; 44: 96-99.
[5] André MC, Hammer J. Life-threatening accidental intravenous epinephrine overdose in a 12-year-old boy. Pediatric Emergency Care. 2019; 35: e110-e112.
[6] Taneli Väyrynen MJ, Luurila HO, Määttä TK, Kuisma MJ. Accidental intravenous administration of racemic adrenaline: two cases associated with adverse cardiac effects. European Journal of Emergency Medicine. 2005; 12: 225-229.
[7] Surineni K, Afzal MR, Barua R, Parashara D. Epinephrine-induced Takotsubo cardiomyopathy. Federal Practitioner. 2020; 33: 28-30.
[8] Paur H, Wright PT, Sikkel MB, Tranter MH, Mansfield C, O’Gara P, et al. High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy. Circulation. 2012; 126: 697-706.
[9] Nazir S, Lohani S, Tachamo N, Ghimire S, Poudel DR, Donato A. Takotsubo cardiomyopathy associated with epinephrine use: a systematic review and meta-analysis. International Journal of Cardiology. 2017; 229: 67- 70.
[10] Jiang JP, Downing SE. Catecholamine cardiomyopathy: review and analysis of pathogenetic mechanisms. Yale Journal of Biology and Medicine. 1991; 63: 581-591.
[11] Gado A, Ebeid B, Axon A. Accidental IV administration of epinephrine instead of midazolam at colonoscopy. Alexandria Journal of Medicine. 2016; 52: 91-93.
[12] Griggs C, Weiner S, Feldman J. Prescription drug monitoring programs: examining limitations and future approaches. Western Journal of Emergency Medicine. 2015; 16: 67-70.
[13] Merlo LJ, Singhakant S, Cummings SM, Cottler LB. Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program. Journal of Addiction Medicine. 2013; 7: 349-353.
[14] Lee J. Propofol abuse in professionals. Journal of Korean Medical Science. 2013; 27: 1451-1452.
[15] Son YJ, Lee EK, Ko Y. Association of working hours and patient safety competencies with adverse nurse outcomes: a cross-sectional study. International Journal of Environmental Research and Public Health. 2019; 16: 4083.
Top