Lidocaine is most often used as a local anesthetic but also may serve as an antiarrhythmic. The most common source of lidocaine poisoning is an unintentional or excessive injection. Toxic effects may occur at a concentration of 6 mcg/mL, but they are common at levels exceeding 10 mcg/mL.
Instructions
1. Identify the common symptoms of lidocaine poisoning. Lidocaine toxicity usually follows a predictable pattern that begins with tongue numbness and lightheadedness. These signs progress to muscle twitches, seizures and unconsciousness followed by a coma and respiratory arrest.
2. Stop the injection immediately if you suspect lidocaine poisoning and prepare for the reaction. Use a face mask or intubate the patient to ensure adequate oxygenation.
3. Control the seizures caused by an overdose of lidocaine with anticonvulsants, such as benzodiazepines and barbiturates. The drugs of choice are diazepam (5 to 10 mg) and thiopental (50 to 100 mg). You can terminate the neuromuscular effects of seizures with succinylcholine, but this will require intubation because succinylcholine paralyzes all muscles.
4. Monitor the cardiovascular system and provide the patient with intravenous fluids and vasopressors as required in cases involving severe reactions. Provide other supportive care as needed for a lidocaine overdose. The use of sodium bicarbonate for the treatment of acute metabolic is controversial.
5. Evaluate the symptoms to determine the etiology for lidocaine poisoning in the absence of a massive overdose. This should include sources of lidocaine from injections of local anesthetics or other medication.
Tags: lidocaine poisoning
