Document Type: Case Report

Authors

1 Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of toxicology, Imam Reza Hospital, Mashhad, Iran

Abstract

Systemic toxemia with topical anesthetics could be fatal due to the use of anesthetics in various ways (oral, intravenous, intramuscular, or subcutaneous). Nowadays, topical anesthetics are used in inpatient and outpatient treatments. Despite its widespread usage, many physicians are not fully aware of the deadly side effects of lidocaine poisoning and its treatment. The objective of this case report is to highlight the diagnosis and treatment of lidocaine toxicity. A 21-year-old woman with a history of multiple suicide attempts ingested approximately three 10% w/w lidocaine sprays. The patient was brought to the emergency department of Imam Reza hospital of Mashhad University of Medical Science with cardiac arrest and respiratory failure. After successful cardiopulmonary resuscitation (CPR), she was admitted to the intensive care unit (ICU). She stayed in ICU for 2 days and we administered dobutamine drip and intravenous lipid emulsion for her then she was transferred to the general ward. We discharged her after 8 days.

Keywords

Main Subjects

1. DeToledo JC. Lidocaine and seizures. Ther Drug Monit 2000; 22(3): 320-2. doi: 10.1097/00007691-200006000- 00014.

2. Nickel JC, Jain P, Shore N, Anderson J, Giesing D, Lee H, et al. Continuous intravesical lidocaine treatment for interstitial cystitis/bladder pain syndrome: safety and efficacy of a new drug delivery device. Sci Transl Med 2012; 4(143): 143ra00. doi: 10.1126/scitranslmed.3003804.

3. Baselt RC. Disposition of Toxic Drugs & Chemicals in Man. Biomedical Publications; 2017.

4. Muroi Y, Chanda B. Local anesthetics disrupt energetic coupling between the voltage-sensing segments of a sodium channel. J Gen Physiol 2009; 133(1): 1-15. doi: 10.1085/ jgp.200810103.

5. Sekimoto K, Tobe M, Saito S. Local anesthetic toxicity: acute and chronic management. Acute Med Surg 2017; 4(2): 152-60. doi: 10.1002/ams2.265.

6. Gangadharan S, Nawathe P, Schleien CL. 40 - Cardiopulmonary resuscitation. In: Coté CJ, Lerman J, Anderson BJ, eds. A Practice of Anesthesia for Infants and Children. 6th ed. Philadelphia: Content Repository Only!; 2019. p. 908-20.e4. doi: 10.1016/b978-0-323-42974- 0.00040-9.

7. Dokken K, Fairley P. Sodium Channel Blocker Toxicity. Treasure Island, FL: StatPearls Publishing; 2020

8. Lee JT, Sanderson CR, Xuan W, Agar M. Lidocaine for cancer pain in adults: a systematic review and metaanalysis. J Palliat Med 2019; 22(3): 326-34. doi: 10.1089/ jpm.2018.0257.

9. Centini F, Fiore C, Riezzo I, Rossi G, Fineschi V. Suicide due to oral ingestion of lidocaine: a case report and review of the literature. Forensic Sci Int 2007; 171(1): 57-62. doi: 10.1016/j.forsciint.2006.05.003.