#MedicalCase

Acute Anaphylactic Reaction. (Critical care physician)

Dr. Zahidul Hasan., MBBS, DFM, MSC EMERGENCY MEDICINE, FELLOSHIP IN EMERGENCY MEDICINE

 

Medical Case Details:

BACKGROUND: Acute anaphylactic reaction is a life threatening medical emergency. Without prompt treatment, patient may die with hypotension and angioedema.

SUMMARY: 37 years old lady came in ER with severe rashes and extensive itching on the whole body since 30 minutes after a black ant bite at home. She was feeling hot flash and vomiting once at home after the incident. She is 4 months pregnant and history of autoimmune hepatitis with Prednisolone and Azathioprine. She was not diabetic or hypertensive.

On examination: She was conscious, blood pressure was 80/50 mm of Hg, Pulse was 98/min, Spo2 was 92% in room air. She has severe urticarial rashes on the whole body and talking without hoarseness. Chest was mild rhonchi bilaterally and no pedal edema. She has started IV fluid normal saline running by two IV cannula. Inj. Chlorpheniramine 10 mg IV stat slowly, Inj. Hydrocortisone 250 mg IV started and given salbutamol nebulization 5 mg. After giving 1 L normal saline, her BP was still 80/50 mm of Hg and pulse was very weak. So given Inj. Adrenaline 0.5 mg (1:1000 dilution) IM. She was feeling shivering and cold due to mild hypothermia. Her temperature was 35.8 C. Warm fluid was given with blanket. She was feeling better after all procedure but BP was still not improving much, so 2nd dose of Inj. adrenaline 0.5mg S/C given. SPo2 was improved after nebulization and O2. Then the lady was admitted for observation.

 


    Discussions


    Dr. C Elanchezhian

    Hello
    Acute Anaphylactic shock Why preferred Inj. Hydro cortisone?
    First line drug is here Inj. Adrenaline..
    Any reason ?
    Please explain sir

    07.Apr, 09:06am

    Dr. Amiya Kumar Chattopadhyay
    Cardiologist

    Ink Adrenaline is the treatment of choice.

    09.Apr, 10:22pm

    Dr. Atul Prakash
    Orthopaedician And Traumatologist

    Ditto, in India we are somewhat averse to using Adr straight away.

    Practicality is in following clear universally accepted pathways rather than anecdotal teachings

    09.May, 06:01am

    Dr. Marcin Zasadowski
    Anesthesiologist

    I guess I´ve decided to use adrenaline as the first chose. But in my opinion, putting hydrocortisone was reasonable due to the patient´s treatment with prednisolone; however, we don't know the dose.

    16.Jul, 12:05am



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