Systemic epinephrine toxicity following topical epinephrine gauze use during burn debridement
- 1Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan *Corresponding author
Abstract
A 54-year-old male with extensive burns caused by a high-voltage alternating current electrical injury underwent three surgical debridement procedures. During the first operation, he developed intraoperative hypertension and tachycardia, followed postoperatively by hypotension, lactic acidosis, hyperglycemia, and hypokalemia, which improved with fluid resuscitation and vasopressor support. Similar hemodynamic and metabolic disturbances recurred during the second debridement. A detailed review of the anesthetic records revealed that epinephrine-soaked gauze had been applied intraoperatively for hemostasis, with vital sign changes occurring shortly thereafter. These findings suggested systemic epinephrine toxicity, followed by hypotension related to antihypertensive therapy. After discussion with the plastic surgery team, topical epinephrine was avoided during the third procedure and replaced with thrombin-soaked gauze, with no recurrence of complications. This case highlights that topical epinephrine used for hemostasis in extensive burn wounds can cause clinically significant systemic toxicity and underscores the importance of interdepartmental communication in preventing perioperative adverse events.
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BibTeX
@article{hiki2026systemic,
title = {{Systemic epinephrine toxicity following topical epinephrine gauze use during burn debridement}},
author = {Honoka Hiki and Tomotaka Takanosu and Chikara Yonekawa and Takashi Mato},
journal = {Turkish Journal of Emergency Medicine},
year = {2026},
month = oct,
doi = {10.4103/tjem.tjem_37_26},
url = {https://doi.org/10.4103/tjem.tjem_37_26},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Systemic epinephrine toxicity following topical epinephrine gauze use during burn debridement
AU - Honoka Hiki
AU - Tomotaka Takanosu
AU - Chikara Yonekawa
AU - Takashi Mato
PY - 2026
DA - 2026/10/10
JO - Turkish Journal of Emergency Medicine
DO - 10.4103/tjem.tjem_37_26
UR - https://doi.org/10.4103/tjem.tjem_37_26
AB - A 54-year-old male with extensive burns caused by a high-voltage alternating current electrical injury underwent three surgical debridement procedures. During the first operation, he developed intraoperative hypertension and tachycardia, followed postoperatively by hypotension, lactic acidosis, hyperglycemia, and hypokalemia, which improved with fluid resuscitation and vasopressor support. Similar hemodynamic and metabolic disturbances recurred during the second debridement. A detailed review of the anesthetic records revealed that epinephrine-soaked gauze had been applied intraoperatively for hemostasis, with vital sign changes occurring shortly thereafter. These findings suggested systemic epinephrine toxicity, followed by hypotension related to antihypertensive therapy. After discussion with the plastic surgery team, topical epinephrine was avoided during the third procedure and replaced with thrombin-soaked gauze, with no recurrence of complications. This case highlights that topical epinephrine used for hemostasis in extensive burn wounds can cause clinically significant systemic toxicity and underscores the importance of interdepartmental communication in preventing perioperative adverse events.
SN - 2452-2473
ER -