9/14/2014 Anaphylaxis: a guide to management : Page 7

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Anaphylaxis: a guide to management
2. What dose of adrenaline would you give the patient?
Your answer
Correct
answer
a.
0.5 ml intramuscular adrenaline 1:1000
b. 0.5 ml subcutaneous adrenaline 1:1000
c. 0.5 ml intravenous adrenaline 1:1000
d. 0.5 ml intravenous adrenaline 1:10 000
a : 0.5 ml intramuscular adrenaline 1:1000
You should give adrenaline as a priority to patients with anaphylaxis (respiratory difficulty, which may be due to laryngeal oedema or asthma, or hypotension,
which may present as fainting, collapse, or loss of consciousness).
The alpha adrenergic stimulation increases peripheral vascular resistance, improving blood pressure and coronary perfusion, reversing peripheral vasodilation, and
decreasing angioedema.
Beta adrenergic stimulation produces positive inotropic and chronotropic cardiac effects, and beta
2
receptor stimulation causes bronchodilation. [ 7 ]
b : 0.5 ml subcutaneous adrenaline 1:1000
You shouldn't give a subcutaneous injection because the adrenaline is absorbed too slowly. [ 8 ]
c : 0.5 ml intravenous adrenaline 1:1000
Intravenous administration is potentially dangerous and should be performed only during ECG monitoring by a trained physician.
d : 0.5 ml intravenous adrenaline 1:10 000
Intravenous administration is potentially dangerous and should be performed only during ECG monitoring by a trained physician.
Learning bite
Another differential diagnosis is angioedema.
9/14/2014 Anaphylaxis: a guide to management : Page 7
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Angioedema may be associated with urticaria, but this is not always due to allergy. Spontaneous urticaria and angioedema is common. Angioedema involving the
upper respiratory tract may result in life threatening airway obstruction, but this is unusual in spontaneous angioedema. Angioedema usually responds to treatment
with antihistamines and, in severe cases, steroids.
Adverse drug reactions should be considered in a patient presenting with angioedema in the absence of urticaria, especially angiotensin converting enzyme (ACE)
inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs). C1 esterase inhibitor deficiency is a rare cause of angioedema without urticaria. It should be
excluded with blood tests (C4 and C1 inhibitor levels) as treatment for this condition is different.
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