Adverse effects of racemic epinephrine in epiglottitis

Acute epiglottitis, a potentially fatal disease, may be difficult to diagnose if the presentation is atypical. We present three such patients who were initially diagnosed as acute laryngotracheitis. They deteriorated rapidly after administration of racemic epinephrine via nebulizer. We caution that: diagnosis of acute epiglottitis should be considered in similar patients; and appropriate precautions must be taken prior to visualization of the airway.