Letters to the Editor

A Pulseless Hand: Accidental Epinephrine Injection

Am Fam Physician. 1998 Mar 15;57(6):1238.

to the editor: While I was working in an emergency room in Kewanee, Ill., a mother brought in her three-year-old child with a short history of a cold feeling in her right hand. Examination showed delayed capillary refill and decreased pulsation of the extremity. Because arterial thrombosis was suspected, the hand surgery service was contacted.

On further questioning, the child revealed that she had been well until she had placed her hand inside her mother's purse. Inside the purse we found a self-propelling epinephrine injector (Epi E-Z Pen), which we assumed had triggered an injection into the child's hand. Local infiltration was performed with phentolamine (Regitine) in a dosage of 1 mg per kg. Return of color and restoration of pulse occurred within three minutes. Accidental injection of epinephrine is expected to be a rare occurrence, but one that requires an index of suspicion for diagnosis and immediate management referral.

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