A Case of Pulseless Ventricular Tachycardia Induced by Iatrogenic Adrenaline Overdose

The patient was a 19-year-old male who had shown no electrocardiogram abnormalities during school medical screening and who had no relevant family medical history. Approximately one year prior to his presentation, he underwent the insertion of an intramedullary nail in the treatment of a left tibial fracture. At the time, a rash appeared after the administration of cefazolin. An allergy to cephem antibiotics was therefore suspected. At his current presentation, when phosphomycin was administered before the removal of the nail, a rash and dyspnea appeared. He was diagnosed with anaphylaxis, and the phosphomycin treatment was stopped and hydrocortisone sodium succinate (300 mg) and adrenaline (1mg) were intravenously administered. Immediately after the injection of adrenaline, the patient noticed chest pain, lost pulse and the monitor showed VT (Figure 1). Emergency medical service was called, cardiopulmonary resuscitation was performed, adrenaline (1 mg) was administered every 3 minutes and automated external defibrillation was performed three times; however, pulseless VT continued. Spontaneous circulation returned 21 minutes after the onset of CPA. The patient was transferred to our center after intubation. His Glasgow Coma Scale score was 9T (E3, V1T, M5). His vital signs were as follows: blood pressure 92/64 mmHg, heart rate 132 beats per minute, respiratory rate 24/min breaths per minute and body temperature 36.8°C. A blood gas analysis performed on admission revealed the following: pH 7.246, PaO2 146.0 mmHg, PaCO2 45.9 mmH, HCO319.3 mmol/L, bicarbonate 19 mmol/L and lactate 88 mg/dL. PaO2/FiO2 (P/F) ratio was 244. The serum CK level was 93 IU/I, CK-MB was 1.4 ng/mL and troponin T was 0.044 ng/mL. Chest radiography and chest CT showed the presence of bilateral pulmonary infiltrates (Figure 2). The electrocardiogram documented sinus tachycardia and ST-segment depression in leads Abstract