Severe Central Nervous System and Cardiovascular Toxicity in a Pediatric Patient After Ingestion of an Over-the-Counter Local Anesthetic : Pediatric Emergency Care

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Severe Central Nervous System and Cardiovascular Toxicity in a Pediatric Patient After Ingestion of an Over-the-Counter Local Anesthetic

Nelsen, Jamie PharmD*; Holland, Michael MD*†; Dougherty, Michelle RN; Bernad, Jason MD§; Stork, Christine PharmD*; Marraffa, Jeanna PharmD*

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Pediatric Emergency Care 25(10):p 670-673, October 2009. | DOI: 10.1097/PEC.0b013e3181b91e8c

Abstract

Dibucaine is considered one of the most potent and consequently toxic amide anesthetics available, and despite withdrawal from the US market as a spinal anesthetic, it remains accessible as an over-the-counter preparation in the United States. Dibucaine exposures in children are infrequently encountered, but to date, all reported consequential ingestions have resulted in death. We report the first case of a potentially fatal dibucaine-induced wide-complex arrhythmia in a child who survived her clinical course without sequelae. It is our hope that this report will highlight the toxicity of dibucaine and prompt a review of its over-the-counter status. The rationale and success of a new antidote, 20% lipid emulsion, for the management of local anesthetic toxicity is discussed.

© 2009 Lippincott Williams & Wilkins, Inc.

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