Xylocaine 2% Jelly Overdosage

Toxicity: Oral Administration: Less than 50 mg seems not impose any risk for toddlers. 75 mg to a 2 years old child caused a mild, 100 mg to a 5 months old child cause serious, 300 + 300 mg within 4 hours to a 3½ years old child caused serious to very serious, 400-500 mg to a 2 year old child and 1 g during 12 hours to a 1 year old child caused very serious intoxication. 600 mg to an adult caused mild, 2 g to an adult caused moderate intoxication.
Parenteral Administration: 50 mg intravenously to a 1 months old child caused very severe intoxication. 200-400 mg infiltration to an adult caused serious, 500 mg to an 80 year old patient and 1 g intravenously to adults caused very severe intoxication.
Topical Administration: 8.6-17.2 mg/kg BW to toddlers when used on burn injured skin caused serious intoxication.
Symptoms: First CNS excitation, later CNS depression. When exposed for large doses the first symptom can be rapidly developing seizures. Agitation, dizziness, visual disturbances, perioral paresthesia, nausea. Later ataxia, auditory disturbances, euphoria, confusion, speech difficulties, paleness, sweating, tremor, seizures, coma, apnoea. Different kinds of arrhythmias especially bradycardial arrhythmias but also if exposed to large doses ventricular tachycardia, ventricular fibrillation, QRS prolongation, atrio-ventricular block. Cardiac failure, hypotension. (rare cases of methaemoglobinaemia are described).
Treatment: If oral exposure, active charcoal. (Provoking vomiting may be hazardous due to anaesthesia of the mucous membrane and the risk for seizures in the early phase. If ventricular lavage is indicated, this should be done with a ventricular tube after tracheal intubation.) Seizures are treated with diazepam. Oxygen. If needed tracheal intubation and controlled respiration (if needed hyperventilation). Bradycardia is treated with atropine. Circulatory deterioration is treated with fluids administrated intravenously, dobutamine and if needed epinephrine (initially 0.05 microg/kg BW/min, to be increased if needed by 0.05 microg/kg BW/min each 10 minutes.), in more severe cases guided by haemodynamic monitoring. Ephedrine may also be tried. If circulatory arrest, resuscitation efforts for several hours may be indicated.