If a patient experiences restlessness and nausea after receiving 2% lidocaine with epinephrine, what should you suspect?

In cases where a patient exhibits restlessness and nausea after the administration of 2% lidocaine with epinephrine, the symptoms are indicative of a potential overdose of epinephrine. Epinephrine is a vasoconstrictor that can cause various systemic effects, particularly when given in higher-than-tolerated doses or in sensitive individuals. These effects can include increased heart rate, anxiety, nausea, tremors, and restlessness.

The patient's restlessness and nausea are classic signs of sympathetic stimulation, which can result from elevated levels of epinephrine. This is particularly relevant if the dosage is relatively high or if the patient has underlying sensitivities or conditions that make them more susceptible to the effects of epinephrine. It's also important to remember that epinephrine can lead to an increase in blood pressure and heart rate, which may further contribute to feelings of anxiety or discomfort.

While an allergic reaction to lidocaine is always a consideration, the acute nature of these symptoms aligns more closely with an overdose scenario than an allergic response, which would typically present with additional signs such as hives or respiratory issues. Local anesthetic failure is less relevant since the patient is presumably experiencing the effects of the lidocaine. A vasovagal response, while it