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Intravenous lidocaine overdosage in a child
Journal of Toxicology. Clinical Toxicology
|January 1, 1986
Summary
A child experienced cardiac arrest and seizures after an accidental intravenous lidocaine hydrochloride overdose. This case highlights the critical importance of accurate dosing and monitoring for local anesthetics in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Clinical Toxicology
- Pharmacology
Background:
- Accidental intravenous administration of local anesthetics can lead to severe toxicity.
- Lidocaine hydrochloride (HCl) is a commonly used local anesthetic and antiarrhythmic agent.
- Pediatric patients are particularly vulnerable to adverse events from medication errors.
Observation:
- A six-year-old child inadvertently received a large dose of intravenous lidocaine HCl (1.2 gm over ~1 hour).
- The child presented with asystole (cardiac arrest) and grand mal seizures.
- Peak lidocaine serum concentration was measured at 19.2 mcg/ml.
Findings:
- The observed clinical manifestations (asystole, seizures) are consistent with severe lidocaine toxicity.
- The high serum lidocaine concentration directly correlated with the adverse events.
- The pharmacokinetic profile of lidocaine in overdose situations is crucial for understanding toxicity.
Implications:
- This case underscores the potential for life-threatening toxicity from lidocaine HCl overdose in children.
- Strict adherence to dosing guidelines and vigilant monitoring are essential to prevent such incidents.
- Understanding lidocaine pharmacokinetics is vital for effective management of overdose cases in pediatric populations.