Article Data

  • Views 2652
  • Dowloads 291

Case Reports

Open Access

Accidental self-injection of intravenous epinephrine by healthcare personnel

  • Hyunseung Koh1
  • Duk Ho Kim1
  • Jinseong Kim1
  • Heebum Yang1

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:


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

Cite and Share

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.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time