Post Your Cases > Lipid emulsion for lidocaine overdose induced status epilepticus seen with no obvious benefit
On 1/20/11 a 6 month old 9kg infant male, with a history of full term gestation, previously well, was brought in to the emergency department by his parents for ingrown toenails bilaterally on both great toes. At approximately 19:00, the physician assistant caring for the pt injected 1.5ml of lidocaine 2% without epinepherine to digital block each great toe. Total lidocaine dose given to the pt was 6.7mg/kg. Toxic dose of lidocaine is >4.5mg/kg.
At 19:50 the pt began having an acute continuous generalized tonic clonic seizure. The pt's vital signs at the onset of seizure activity was Temp 97.9 HR 177 BP 94/71 RR 38
Two Intalipid 20% bolus infusions of 1.5ml/kg were given at 20:13 and 20:16 followed by a 60 minute continuous infusion of 0.25ml/kg/min seen without change in the pt's seizure activity.
A Phenobarbital 20mg/kg loading dose was started at 20:25.
The pt stopped seizing at 21:09 and remained seizure free until transfer to a pediatric inpatient ICU at 23:56.
The pt remained hemodynamically stable throughout his entire stay in the emergency department without any hypotensive episodes and continued in sinus rhythm with heart rates between 122-200.
In this case, for a neurologic complication of lidocaine overdose, lipid emulsion therapy did not seem to provide obvious benefit. Conversely lipid emulsion infusion did not appear to have any adverse effects. January 21, 2011 | David Loya
At 19:50 the pt began having an acute continuous generalized tonic clonic seizure.
The pt's vital signs at the onset of seizure activity was Temp 97.9 HR 177 BP 94/71 RR 38
Despite 3 subsequent ativan 0.7mg IVP infusions, generalized seizure activity persisted.
Two Intalipid 20% bolus infusions of 1.5ml/kg were given at 20:13 and 20:16 followed by a 60 minute continuous infusion of 0.25ml/kg/min seen without change in the pt's seizure activity.
A Phenobarbital 20mg/kg loading dose was started at 20:25.
The pt stopped seizing at 21:09 and remained seizure free until transfer to a pediatric inpatient ICU at 23:56.
The pt remained hemodynamically stable throughout his entire stay in the emergency department without any hypotensive episodes and continued in sinus rhythm with heart rates between 122-200.
In this case, for a neurologic complication of lidocaine overdose, lipid emulsion therapy did not seem to provide obvious benefit. Conversely lipid emulsion infusion did not appear to have any adverse effects.
January 21, 2011 | David Loya