Severe central nervous system and cardiovascular toxicity in a pediatric patient after ingestion of an over-the-counter local anesthetic

Jamie Nelsen, Michael Holland, Michelle Dougherty, Jason Bernad, Christine Stork, Jeanna Marraffa
Pediatric Emergency Care 2009, 25 (10): 670-3
Dibucaine is considered one of the most potent and consequently toxic amide anesthetics available, and despite withdrawal from the US market as a spinal anesthetic, it remains accessible as an over-the-counter preparation in the United States. Dibucaine exposures in children are infrequently encountered, but to date, all reported consequential ingestions have resulted in death. We report the first case of a potentially fatal dibucaine-induced wide-complex arrhythmia in a child who survived her clinical course without sequelae. It is our hope that this report will highlight the toxicity of dibucaine and prompt a review of its over-the-counter status. The rationale and success of a new antidote, 20% lipid emulsion, for the management of local anesthetic toxicity is discussed.

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