Epinephrine has a variety of clinical uses one is its use as a topical hemostatic agent on bleeding surfaces, such as in the mouth. We report a temporal association between the administration of topical epinephrine and the development of metabolic acidosis during general anesthesia. A 21 year-old patient, with facial asymmetry, had undergone orthognatic surgery. During the operation, serial blood gas analysis revealed the onset of a metabolic acidosis following the local infiltration (0.036 mg) and topical application of a high dose of epinephrine-Bosmin^® (1:1,000 epinephrine). The metabolic acidosis resolved within 5 hours.