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PEDIATRICS Vol. 104 No. 1 July 1999, p. e9

ELECTRONIC ARTICLE:
Pediatric Myocardial Infarction After Racemic Epinephrine Administration

Received Jul 24, 1998; accepted Feb 8, 1999.

Manish J. Butte*, Bac X. NguyenDagger , Tim J. Hutchison§, James W. Wiggins, and James W. ZieglerDagger

From the * Graduate Group in Biophysics, University of California San Francisco, San Francisco, California; the Dagger  Department of Pediatrics, Brown University School of Medicine, Providence, Rhode Island; § North Colorado Medical Center, Greeley, Colorado; and the  Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital, Denver, Colorado.

Myocardial infarction is a previously unreported complication of treatment with racemic epinephrine that is used commonly in the emergency department for severe respiratory distress in bronchiolitis or croup syndrome. We describe a pediatric patient who presented with the croup syndrome and severe respiratory distress that required multiple doses of nebulized racemic epinephrine in the emergency department. The patient developed ventricular tachycardia and mild chest discomfort during one treatment, which resolved spontaneously on discontinuation of the nebulization. Persistently abnormal electrocardiograms and elevated creatine phosphokinase MB isoenzyme (CPK-MB) levels suggested a myocardial infarction had occurred. Subsequent echocardiography, cardiac catheterization, and angiography revealed an anatomically normal heart with normal coronary circulation; however, a stress nuclear study showed a small myocardial infarct. The significance of this previously unreported complication of racemic epinephrine is discussed, along with recommendations for proper use in the emergency department.

 Key words:  racemic epinephrine, croup, myocardial infarction, ischemia, arrhythmia.




P3Rs:

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Possibility of prior coronary arteritis as a cause fo the MI
Sanjay Prabhu
Pediatrics Online, 15 Jul 1999 [Full text]
Hypoxia with vasospasm may be the cause of MI
Yalamanchali Chowdary
Pediatrics Online, 25 Aug 1999 [Full text]