Iatrogenic Epinephrine Overdose Resulting in Transient Cardiac Dysfunction in a Pediatric Patient

Iatrogenic epinephrine overdose and subsequent development of transient myocardial dysfunction have been reported in the adult literature, though to a far lesser extent in children. The aim of this report is to describe a reversible, transient cardiac functional impairment in an otherwise healthy 13-year-old adolescent male after inadvertent intravenous epinephrine administration for anaphylaxis. Following epinephrine administration, the patient presented with hypotension and respiratory failure, with electrocardiographic changes suggestive of ischemia and depressed cardiac function on echocardiogram. The patient's symptoms resolved within 24 hours without need of pharmaceutical therapies, and the comprehensive work-up failed to identify other contributory etiologies. His myocardial function improved in follow-up. Although rare, this case illustrates the importance of careful administration of high-risk medications and close monitoring of critical side effects such as cardiac dysfunction following epinephrine administration in pediatric patients.