Background
Lidocaine is a widely known drug used as a topical and local anesthetic and can be used as an antiarrhythmic drug. Lidocaine is relatively more neurotoxic compared to other local anesthetics especially if applied in high concentrations directly to vascular or neural compartments. Many cases were reported with fatal lidocaine toxicity after injection, but lidocaine toxicity due to the topical application or oral ingestion is uncommon.
Cases
Two cases of fatal lidocaine intoxication were presented to our center. The first case was a male with a history of multiple drug abuse who suffered from generalized seizures followed by cardiopulmonary arrest after oral ingestion of lidocaine spray. The second case was a female who suffered from generalized seizures followed by cardiopulmonary arrest during committing criminal abortion with the unknown route of administration of lidocaine which was discovered by toxicological analysis. A full autopsy was done in both cases and specimens were taken from both cadavers for both toxicological analysis and histopathological examination. Both autopsy findings and histopathological examination revealed non-specific results, but toxicological examination revealed toxic levels in all specimens.
Conclusion
Although the rarity of non-iatrogenic lidocaine intoxication, it should be suspected as the cause of death if victims suffered from seizures during suspicious circumstantial evidence.