Accidental self injection of EpiPens

We recently reported a case of a 9 year old non-allergic boy who accidentally injected his sister’s EpiPen into his thumb (see Of interest we found in 2015 the Australian Database of Adverse Event Notifications documented no cases of self-injection (or ‘Injury associated with device’) for EpiPen or EpiPen Jr but in the same period, there were 94 calls to the NSW Poisons Information Centre alone about accidental self-injection with adrenaline auto-injectors. This is likely to be an under-representation of the true number of cases of self-injection with adrenaline auto-injectors.

Adrenaline should not be injected into fingers due to the risk of reduced  local perfusion and thus infarction (i.e. tissue death). No cases of digital infarction with adrenaline alone has been reported (only in cases where a local anaesthetic has been mixed with adrenaline).

If self injection of digits occur with adrenaline auto-injectors we suggest:

  1. The affected digit be massaged in warm water.
  2. Going to hospital for review, in case the finger remains poorly perfused
  3. Getting a new replacement adrenaline auto-injector
  4. Reporting the incident to the Therapeutic Goods Administration (via a ‘Users Medical Device Incident’ online report; this can be made by the parent/carer)