Abstract
We report a case of sudden death after gingival injection of lidocaine, which made us suspect overdosing or anaphylactic shock. Using liquid chromatography-mass spectrometry (LC-MS), we measured the lidocaine concentrations in whole blood and tissues including the gingivae. The lidocaine concentration in blood (0.70 μg/ml) was lower than the therapeutic level. Lidocaine levels distributed to various organs were also low. Among them, the lung showed the highest level, followed by the liver, brain, and spleen. The concentrations in the gingivae with and without pus were 938 μg/g and 1048 μg/g, respectively. Together with the above analytical data, we made histopathological examinations, and tryptase and immunoglobulin E (IgE) assays as markers of anaphylactic shock. Macroscopically, myocardial ischemic changes were observed over relatively large areas. In such cardiac areas, there were focal necrosis, disarrangement of cardiac muscles, and stromal edema microscopically. The tryptase value was within the normal range. By carefully considering all data obtained from the victim, we diagnosed that the victim died of heart failure under the stress of the dental treatment.
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