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Hospital: Green City Hospital, Basundhara, Kathmandu, Nepal
Victims: None
Type of violence: Physical
Event: A patient with fever with the diagnosis of typhoid and pneumonia was admitted in the hospital. The patient had to be prescribed adrenaline and patient had used 7 out of 10 doses bought. After the mortality of the patient, when relatives returned the remaining 3 doses to the pharmacy, they found that they were expired. The relatives then claimed that the death was due to the expired medicines and vandalized the hospital. The pharmacist was also caught by the police.
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Can expired adrenaline or epinephrine kill?
The original parenteral epinephrine remains sterile and detectably pure more than 2.5 years after expiration.
Weir WB, Fred LY, Pike M, Rubakhin SS, Ludwig TJ, Shar AM, Zhu L, Frederick A, Uzoaru I, Wang L, Sweedler JV. Expired Epinephrine Maintains Chemical Concentration and Sterility. Prehosp Emerg Care. 2018 Jul-Aug;22(4):414-418. doi: 10.1080/10903127.2017.1402109. Epub 2018 Jan 26. PMID: 29373043.
While we certainly recommended replacing all expired medications, we recognize that can be cost-prohibitive for a lot of Americans. So, if a person has a severe allergic reaction and their only option is expired epinephrine, it is preferred over no medication at all.
Epinephrine solutions that are within 24 months of their expiration date typically have at least 90 percent of the label dose; solutions within 50 months of their expiration date still have as much as 88 percent. In the specific case of anaphylaxis—which is a life-threatening emergency—administering expired epinephrine if that is your only choice, is better than just waiting for emergency medical services (EMS) to arrive.