Systemic epinephrine toxicity following topical epinephrine gauze use during burn debridement
Honoka Hiki
, Tomotaka Takanosu, Chikara Yonekawa, Takashi Mato
Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
Keywords: Burn injury, epinephrine, hemodynamic instability, patient safety, systemic toxicity
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.
How to cite this article: Hiki H, Takanosu T, Yonekawa C, Mato T. Systemic epinephrine toxicity following topical epinephrine gauze use during burn debridement. Turk J Emerg Med 2026;26:355-8.
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
HH: Conceptualization (lead), review of the literature (lead), writing – original draft (lead). TT: Conceptualization (lead), review the literature (lead), writing – review and editing (lead). CY, TM: Writing – review and advise (equal).
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