Accidental Adrenaline Injection in a Non-anaphylactic Child Causes Acute Kidney Injury

A 14-year-old male was erroneously administered i.v. Adrenaline 6 mg (1:1000), which led to immediate severe abdominal pain, vomiting, gastrointestinal (GI) bleeding, along with severe respiratory distress.

The child was diagnosed with neurocysticercosis, and appropriate treatment was ongoing. This mishap resulted from an error by the hospital staff. 

On examination, the patient was irritable; bilateral crept on the chest, abdominal guarding, and rigidity were noted. Clinical parameters showed – tachycardia, tachypnea, hypertension (148/98 mm Hg), and SpO2 76% at room air.

Investigations depicted:

Hemoglobin 11.9 mg/dl

Total leukocyte count 24,000

Platelets 2.68 Lacs

PT 17 seconds

aPTT 32 seconds

INR 1.23

urea 27 mg/dL

creatinine 0.8 mg/dl

CXR Pulmonary edema

ECG Sinus tachycardia

ABG Metabolic acidosis

Management

• Supportive – oxygen therapy, i.v. fluids

• Inj. Hydrocortisone

• Inj. Furosemide

• Inj. tranexamic acid and vitamin K

The patient responded well. Gastrointestinal bleeding was controlled, and blood pressure normalized within half an hour. Four hours later – hypotension, inj. Dopamine was administered – vitals normalized within 24 hours. Other symptoms included vomiting. Repeat investigation showed acute kidney injury (AKI) three days after mistaken adrenaline inj. 

The patient was referred for hemodialysis. His kidney function test (KFT) normalized after one dialysis cycle. Follow-up reports suggested a normal kidney function test. 

Adrenalin toxicity can lead to renal failure; it should be monitored cautiously.