Abstract
BackgroundAdrenaline is the standard treatment for anaphylaxis but appropriate administration remains challenging, and iatrogenic overdose is easily overlooked. Despite the established importance of pediatric blood pressure measurement, its use remains inconsistent in clinical practice.Case presentationWe report a case of adrenaline overdose in a 9-year-old white boy with anaphylaxis, where signs of adrenaline overdose were indistinguishable from progressive shock until blood pressure measurement was taken.ConclusionsThe consequences of under-dosing adrenaline in anaphylaxis are well-recognized, but the converse is less so. Blood pressure measurement should be a routine part of pediatric assessment as it is key to differentiating adrenaline overdose from anaphylactic shock.
Highlights
BackgroundAnaphylaxis, the most severe form of allergic reaction, is a life-threatening multi-systemic inflammatory process [1, 2] mediated by immunoglobulin E (IgE) [3]
Adrenaline is the standard treatment for anaphylaxis but appropriate administration remains challenging, and iatrogenic overdose is overlooked
We describe a case of adrenaline overdose in a child experiencing anaphylaxis, and discuss the role of blood pressure to differentiate progression of anaphylaxis symptoms from adrenaline toxicity
Summary
Anaphylaxis, the most severe form of allergic reaction, is a life-threatening multi-systemic inflammatory process [1, 2] mediated by immunoglobulin E (IgE) [3]. Twenty minutes into the event, on the presumption of refractory anaphylactic shock, an intravenous adrenaline infusion was commenced at 10 μg per minute His blood pressure was not measured during the event or on the journey to the hospital. Liew and Craven Journal of Medical Case Reports (2017) 11:129 suspected and the adrenaline infusion was immediately ceased He received two separate doses of 2 mg intravenously administered ondansetron for the vomiting with little effect. The rapid improvement in his blood pressure, agitation, and vomiting following cessation of the adrenaline infusion supported the diagnosis of adrenaline overdose. In view of his asthma, he was given intravenously administered hydrocortisone and rescue nebulizers (salbutamol and ipratropium) to control his respiratory symptoms. He was admitted to our hospital, observed for 24 hours and discharged home with no further sequelae
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