Lidocaine overdose: Another preventable case?

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Chad Abby Date: 3/20/2009
Article title: Lidocaine Overdose: Another Preventable Case?
Author(s): Javier Gonzalez, Suman Wason, Richard Druckenbrod
Journal: Pediatric Emergency Care
Volume (number): Vol. 10, No. 6
Month, Year: 1994
Major topic: Lidocaine use
Minor topic(s: Lidocaine overdose
Type of Article: Case report
Main Purpose: A case report of a child who suffered central nervous system toxicity following the administration of viscous lidocaine prescribed for the treatment of painful lesions caused by acute herpetic gingivostomatitis.
Findings: This case report showed increased absorption, decreased clearance and prolonged half-life in comparison to adults. This would lead to higher blood concentrations in children than adults for an equivalent mg/kg dose.
Key points/Summary : 15 month old child presented with AHG and impetigo was prescribed oral amoxicillin and bacitracin and was given 2% viscous lidocaine and was instructed to administer a dose of ½ teaspoon (50mg) every 2-3 hours prn. This treatment was continued for five days before the child presented to the emergency room having five tonic-clonic seizures. He reportedly developed central cyanosis and required intubation by the hospital team upon presentation – reported healthy history. Child had a 100F temp, HR of 140bpm, and respiration of 20 per min. Serum lidocaine level four hours after last dose was 8 micrograms/ml. The child was discharged in good condition and had no further seizures. Lidocaine is the most commonly prescribed topical anesthetic for painful oral ulcerations and teething discomfort. Unlike adults children are often uncooperative and anxious who in order to provide maximum comfort to their children may interpret instructions more generously, leading to overdose. When lidocaine is absorbed from the oral mucosa it bypasses the liver and is distributed to the body in much greater concentrations. Side effects produced by lidocaine overdose include central nervous system stimulation with seizures and cardiovascular effects such as hypotension, bradycardia, and cardiac arrest. Doses of lidocaine that are innocuous for adults may present a significant potential toxic hazard in children. Lidocaine should not be used in children to treat painful mouth lesions. Antihistamines seem to be a better choice for mouth lesions.
Assessment of article: Good article to read. Be careful when prescribing lidocaine, make sure the child is older and have it only prescribed as a rinse and spit.