Fatal Systemic Toxicity with Topical Lidocaine Spray

Abstract

Introduction: Lidocaine is a class of Ib antiarrhythmic agent which is available in various intravenous (IV) and topical forms. Systemic toxicity of lidocaine has been reported following its IV injection or local infiltration for anesthesia, mostly. However, toxicity following the application of its topical gel and oral spray is also possible. Manifestations of lidocaine induced systemic toxicity include neurologic and cardiac symptoms. Reported cases of systemic toxicity after ingestion of topical lidocaine are rare. In this case study, we present a patient who developed symptoms of severe systemic toxicity following oral ingestion of topical lidocaine spray.Case Presentation: A young woman was referred to the emergency department with agitation following ingestion of lidocaine spray solution to commit suicide. At the time of arrival, vital signs were stable. Blood tests and electrocardiogram were also normal. She underwent supportive care. Gradually, the symptoms of neuro and cardiac toxicity appeared. Standrad management include intralipid and bicarbonate administration was unsuccesfull and the patient experienced cardiac arrest.Conclusion: Lidocaine systemic toxicity with topical form could be severe and fetal, since the prompt diagnosis of systemic toxicity is the key factor to preventing death, physicians should be familiar with the symptoms of lidocaine systemic toxicity.