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

Systemic epinephrine toxicity is a rare complication following inadvertent, excessively large, rapid subcutaneous, intramuscular, or intravenous administration. Signs and symptoms of epinephrine toxicity include the rapid onset of transient agitation, hypertension, tachycardia, lactic acidosis, and dysrhythmias with potentially fatal consequences. This is a case report of 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, headaches, 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. This case report explains the potential adverse outcome of topical epinephrine use to help create awareness of the possibility of systemic epinephrine toxicity.