Q: Is Xylocaina EV – HCl Lidocaine and epinephrine a sufficient replacement of epinephrine ampules in a case of anaphylaxis?

Q:  I went to the pharmacy looking for ampules of epinephrine, but they do not sell it. Instead, they sold me Xylocaina EV – HCl Lidocaine and epinephrine.. Each ml has Lidocaine HCl monohydrate equal to 20mg of HCl of Lidocaine and ‘bitartrato of epinephrine equal to 0.005mg of epinepherine. In an emergency situation, where we are over 2 hours away from definitive care, would an injection of this drug do more harm than good to a normal patient with anaphylactic shock from a bee or wasp sting? I was also told that this drug is beneficial for stingray attacks. Is this true? If so, could you please recommend a dosage for each scenario.

A:  Thanks for the query.  Simply put, delivering the proper dose of epinephrine using this mixture would require a large volume and a toxic dose of lidocaine.  If you do the math, you would need 60 mL to administer 0.3mg of epinephrine which would include 1200 mg (1.2 gm) of lidocaine.  Anything over 300 mg of lidocaine is considered potentially toxic in an adult.

Could this combination help with a stingray puncture?  Lidocaine is a local anesthetic used for suturing so theorectically it could help to temporarily ease the pain if injected locally.  But remember, injecting lidocaine is not part of the scope of practice of a WFR and would therefore be a real stretch.  Besides, immersion in hot water works quite well.

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