Annals of Emergency Medicine
Volume 55, Issue 4 , Pages 341-344 , April 2010

Confusion About Epinephrine Dosing Leading to Iatrogenic Overdose: A Life-Threatening Problem With a Potential Solution

  • Manreet Kanwar, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, St. John Hospital and Medical Center, Detroit, MI
    • ,
  • Charlene B. Irvin, MD

      Affiliations

    • Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, MI
    • Corresponding Author InformationAddress for correspondence: Charlene B. Irvin, MD, 50572 Jefferson Ave, New Baltimore, MI 48047; 586-716-1701, fax 313-343-7620
    • ,
  • John J. Frank, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, St. John Hospital and Medical Center, Detroit, MI
    • ,
  • Kathryn Weber, PharmD

      Affiliations

    • Department of Pharmacy, St. John Hospital and Medical Center, Detroit, MI
    • ,
  • Howard Rosman, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, St. John Hospital and Medical Center, Detroit, MI

Received 10 September 2009 ,Revised 3 November 2009 ,Accepted 6 November 2009.

References 

  1. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112:1–211
  2. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112:IV-58–IV-66
  3. Budhwani N, Bonaparte KL, Cuyjet AB, et al. Severe reversible left ventricular systolic and diastolic dysfunction due to accidental iatrogenic epinephrine overdose. Rev Cardiol Med. 2004;5:130–133
  4. Sood JD, Eripson M, Fitzharris P, et al. Too much of a good thing, is it bad? (Adrenaline on trial). N Z Med J. 2007;120:U2494
  5. Fyfe AI, Daly PA, Dorian P, et al. Reversible “cardiomyopathy” after accidental adrenaline overdose. Am J Cardiol. 1991;67:318–319
  6. Kurachek SC, Rochoff MA. Inadvertent intravenous overdose of racemic epinephrine. JAMA. 1985;253:1441–1442
  7. Carter BT, Westfall VK, Heironimus TW, et al. Severe reaction to accidental subcutaneous administration of large dose of epinephrine. Anaesth Analg. 1971;50:175–178
  8. Zeller B, Bangstad HJ. Accidental administration of racemic epinephrine: 3 life-threatening cases after intravenous injection in children. Tidsshr Nor Laegeforen. 1998;118:1080–1081
  9. Campbell R. Cardiovascular effects of epinephrine overdose: case report. Anesth Prog. 1977;24:190–193
  10. Litvinov I, Kotowycz M, Wassman S. Iatrogenic epinephrine-induced reverse Takotsubo cardiomyopathy: direct evidence supporting the role of catecholamines in the pathophysiology of the “broken heart syndrome.”. Clin Res Cardiol. 2009;98:457–462
  11. Meaudre E, Barbou F, Sallabury M, et al. Rapid reversal of global left ventricular dysfunction after accidental injection of 0.75 mg epinephrine in a 20-year-old patient. Acta Anaesthesiol Scand. 2004;48:914–916
  12. Rolfe S, Harper NJ. Ability of hospital doctors to calculate drug doses. BMJ. 1995;310:1173–1174
  13. Lesar TS, Briceland L, Stein DS. Factors related to errors in medication prescribing. JAMA. 1997;277:312–317
  14. Let's stop this “Epi” demic! Preventing errors with epinephrine. Patient safety advisory. http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2006/Sep3(3)/Pages/16.aspxAccessed November 6, 2007
  15. Wheeler DW, Carter JJ, Murray LJ, et al. The effect of drug concentration expression on epinephrine dosing errors: a randomized trial. Ann Intern Med. 2008;148:11–14
  16. Lightfoot CB, Abraham RJ, Mammen T, et al. Survey of radiologists' knowledge regarding the management of severe contrast material–induced allergic reactions. Radiology. 2009;251:691–696

 Supervising editor: E. Martin Caravati, MD, MPH

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online January 19, 2010.

 Reprints not available from the authors.

PII: S0196-0644(09)01718-1

doi: 10.1016/j.annemergmed.2009.11.008

Annals of Emergency Medicine
Volume 55, Issue 4 , Pages 341-344 , April 2010

Article Tools

* Image Usage & Resolution