Case report
Treatment of accidental digital injection of epinephrine

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The use of epinephrine auto-injectors for prehospital treatment of severe allergic reactions has become increasingly popular in recent years. Anxiety when patients are called on to use these spring-loaded devices may lead to complications. We present the case of a 28-year-old woman who accidentally injected epinephrine 1:1,000 solution 0.3 mL into her right index finger with an automatic epinephrine injector. The approach to the treatment of these complications has been varied in the literature, including local sympathectomy, topical nitrates, and either local or intra-arterial phentolamine. This potentially disabling case of epinephrine-induced vasospasm of digital arteries was treated successfully with local infiltration of phentolamine.

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    The second case involved surgical debridement of a finger infection in a patient with scleroderma and Raynaud phenomenon and the authors concluded that the necrosis was likely caused by the infection, pre-existing microvascular damage, or excessive necrosis caused by the laser ablation rather than the lidocaine. Several case reports have been published on accidental injection of high-concentration (1:1,000) epinephrine into the hand and fingers.9–19 In most of these cases, the effect of epinephrine was reversed using phentolamine.

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Presented at the AAPCC/AACT/ABMT/CAPCC Annual Scientific Meeting in Tucson, Arizona, September 1990.

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