Case Report: Epinephrine-Containing Topical Anesthetic Gel Inducing Systemic Epinephrine Toxicity

Systemic epinephrine toxicity is a rare complication following inadvertent or excessively large or rapid subcutaneous, intramuscular or intravenous administration. Signs and symptoms of epinephrine toxicity include rapid onset of transient agitation, hypertension, tachycardia, lactic acidosis, and dysrhythmias with potentially fatal consequences. In this case report, we present a 33-year-old female who experienced epinephrine toxicity following the use of a topical anesthetic cream containing lidocaine and epinephrine. The patient had multiple applications to her chest before and during tattoo placement which led to tachycardia, elevated blood pressure, headache, chest pain, nausea, vomiting, and anxiety. The patient was brought into the ED where her vital signs had begun to normalize but laboratory analysis was concerning for severe lactic acidosis and non-ST elevation myocardial infarction. After admission to the hospital the patient’s symptoms quickly improved, the lactic acidosis resolved, and further workup was unrevealing. Our goal of this case report is to educate clinicians that topical epinephrine anesthetic gel use can cause systemic epinephrine toxicity. We aim to create mindfulness of the symptoms of epinephrine toxicity and management