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Infant with status epilepticus secondary to systemic lidocaine toxicity from topical application

Erica Walters1, Victoria Wurster Ovalle2, Shan Yin3,4

  • 1Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

BMJ Case Reports
|January 15, 2020
PubMed

Insights

A toddler experienced seizures from topical lidocaine cream, a rare cause of status epilepticus. Prompt recognition and management of lidocaine toxicity are crucial for pediatric emergencies.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Toxicology

Background:

  • Topical lidocaine is frequently used for various pediatric skin conditions.
  • Systemic absorption can lead to toxicity, particularly in infants.

Observation:

  • An 11-month-old infant presented with status epilepticus, initially without a clear trigger.
  • The infant had recently been prescribed 4% topical lidocaine cream for a groin rash.

Findings:

  • The patient was diagnosed with systemic lidocaine toxicity as the cause of seizures.
  • Seizure activity resolved with benzodiazepines and fosphenytoin.
  • The infant was monitored in the ICU with no cardiovascular complications or seizure recurrence.

Implications:

  • Emergency medicine providers should consider lidocaine toxicity in the differential diagnosis of status epilepticus in infants.
  • Awareness of potential complications from topical lidocaine is essential for safe pediatric prescribing.
  • Prompt recognition and management can prevent severe outcomes from lidocaine toxicity.

Keywords:
epilepsy and seizuresneurology (drugs and medicines)paediatrics (drugs and medicines)poisoning

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