Skip to main content
Journal cover image

Refractory status epilepticus after inadvertent intrathecal injection of tranexamic acid treated by magnesium sulfate.

Publication ,  Journal Article
Hatch, DM; Atito-Narh, E; Herschmiller, EJ; Olufolabi, AJ; Owen, MD
Published in: Int J Obstet Anesth
May 2016

We present a case of accidental injection of tranexamic acid during spinal anesthesia for an elective cesarean delivery. Immediately following intrathecal injection of 2mL of solution, the patient complained of severe back pain, followed by muscle spasm and tetany. As there was no evidence of spinal block, the medications given were checked and a 'used' ampoule of tranexamic acid was found on the spinal tray. General anesthesia was induced but muscle spasm and tetany persisted despite administration of a non-depolarizing muscle relaxant. Hemodynamic instability, ventricular tachycardia, and status epilepticus developed, which were refractory to phenytoin, diazepam, and infusions of thiopental, midazolam and amiodarone. Magnesium sulfate was administered postoperatively in the intensive care unit, following which the frequency of seizures decreased, eventually stopping. Unfortunately, on postoperative day three the patient died from cardiopulmonary arrest after an oxygen supply failure that was not associated with the initial event. This report underlines the importance of double-checking medications before injection in order to avoid a drug error. As well, it suggests that magnesium sulfate may be useful in stopping seizures caused by the intrathecal injection of tranexamic acid.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Int J Obstet Anesth

DOI

EISSN

1532-3374

Publication Date

May 2016

Volume

26

Start / End Page

71 / 75

Location

Netherlands

Related Subject Headings

  • Tranexamic Acid
  • Status Epilepticus
  • Receptors, GABA-A
  • Medication Errors
  • Magnesium Sulfate
  • Injections, Spinal
  • Humans
  • Female
  • Cesarean Section
  • Antifibrinolytic Agents
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hatch, D. M., Atito-Narh, E., Herschmiller, E. J., Olufolabi, A. J., & Owen, M. D. (2016). Refractory status epilepticus after inadvertent intrathecal injection of tranexamic acid treated by magnesium sulfate. Int J Obstet Anesth, 26, 71–75. https://doi.org/10.1016/j.ijoa.2015.11.006
Hatch, D. M., E. Atito-Narh, E. J. Herschmiller, A. J. Olufolabi, and M. D. Owen. “Refractory status epilepticus after inadvertent intrathecal injection of tranexamic acid treated by magnesium sulfate.Int J Obstet Anesth 26 (May 2016): 71–75. https://doi.org/10.1016/j.ijoa.2015.11.006.
Hatch DM, Atito-Narh E, Herschmiller EJ, Olufolabi AJ, Owen MD. Refractory status epilepticus after inadvertent intrathecal injection of tranexamic acid treated by magnesium sulfate. Int J Obstet Anesth. 2016 May;26:71–5.
Hatch, D. M., et al. “Refractory status epilepticus after inadvertent intrathecal injection of tranexamic acid treated by magnesium sulfate.Int J Obstet Anesth, vol. 26, May 2016, pp. 71–75. Pubmed, doi:10.1016/j.ijoa.2015.11.006.
Hatch DM, Atito-Narh E, Herschmiller EJ, Olufolabi AJ, Owen MD. Refractory status epilepticus after inadvertent intrathecal injection of tranexamic acid treated by magnesium sulfate. Int J Obstet Anesth. 2016 May;26:71–75.
Journal cover image

Published In

Int J Obstet Anesth

DOI

EISSN

1532-3374

Publication Date

May 2016

Volume

26

Start / End Page

71 / 75

Location

Netherlands

Related Subject Headings

  • Tranexamic Acid
  • Status Epilepticus
  • Receptors, GABA-A
  • Medication Errors
  • Magnesium Sulfate
  • Injections, Spinal
  • Humans
  • Female
  • Cesarean Section
  • Antifibrinolytic Agents