There is little in the literature to guide dosing of topical anesthetics over burn sites, other than the absorption appears higher when the product is applied over thermal injury than over surgically induced wounds. 2 Based on the patient’s weight, the administered dose was 15 times the recommended intravenous dose. The recommended maximum dose of topical lidocaine is 4.5 mg/kg.
Otc numbing cream skin#
1 Manufacturer’s warnings prohibit use over large areas of the body, in deep or puncture wounds, on animal bites or on serious burns ( The amount of lidocaine administered in our case was 750 mg (75 mg/kg) on burned skin over 15% of the patient’s body surface area. The lidocaine in Polysporin Kids Cream is a solid pure base and forms an oil-in-water emulsion, which allows a higher concentration of the active ingredient per emulsion droplet for enhanced skin penetration. The case was reported to Vigilance Canada.Įstablishing a probable diagnosis of lidocaine toxicity In the approximately three and a half years since then, the patient has remained seizure free. No other sources of toxins or fever were identified on further history-taking, and the patient and his family had no history of seizures.Īt follow-up two weeks after discharge, the patient had had no further seizures and had normal findings on an electroencephalogram. The intravenous treatment with acyclovir, cefotaxime and vancomycin was continued until subsequent cultures showed no bacterial or viral infection, and the patient was discharged home. He was extubated the next day, weaned from inotropes and transferred back to his local hospital. The patient was transferred to an out-of-province pediatric intensive care unit after his condition was stabilized. A computed tomography scan showed no obvious pathology. An initial toxic screen was positive only for opiates. Cerebral spinal fluid analysis showed clear fluid, with normal values for cell count, glucose, protein and lactate dehydrogenase levels. The first sample was not processed, and the second showed a serum lidocaine level of less than 1 μmol/L. Blood samples obtained about two and five hours after initial lidocaine exposure were sent to the provincial laboratory for lidocaine measurement. The fraction of inspired oxygen was 60%, and the methemoglobin level was 1.1%. Initial arterial blood gas levels were as follows: pH 7.2, partial pressure of carbon dioxide (Paco 2) 47 mm Hg, partial pressure of oxygen 119 mm Hg, bicarbonate 18 mmol/L, base excess –10 and oxygen saturation 97.8%. Acyclovir, cefotaxime and vancomycin were given intravenously to treat possible infectious causes of the seizures. A dopamine infusion was begun because of hypotension and titrated to keep the patient’s systolic blood pressure above 80 mm Hg. Midazolam and fentanyl infusions were started for maintenance sedation. After establishment of intravenous access, propofol and fentanyl were administered, followed by phenobarbital, which subsequently controlled the seizures.įollowing cessation of the seizures, a loading dose of phenytoin was administered. Intraosseous access was established, and four doses of both lorazepam (total 4 mg) and midazolam (total 4 mg) were administered via this access however, the seizures continued. His airway was secured with an endotracheal tube, without sedation because there was no intravenous access in place. The health care team applied the entire 15-g tube of the cream, which contained 750 mg of lidocaine in total, during the dressing change.Ībout 20 minutes later, while waiting for discharge, the child had a generalized tonic–clonic seizure. They requested that the cream be applied during the dressing change. Before bringing him to the emergency department, his parents had spontaneously purchased Polysporin Kids Cream, which contains 5% lidocaine hydrochloride by weight. The patient’s pain was being controlled with oral morphine and codeine. His vaccinations were up to date, and he had been previously well.
The burns affected about 15% of his body surface area. He had been burned on the chin, neck and chest from scalding liquid at home the previous day. A 17-month-old boy was brought to the emergency department for dressing changes to first- and second-degree burns.
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