Epinephrine in Anaphylaxis: Higher Risk of Cardiovascular Complications and Overdose After Administration of Intravenous Bolus Epinephrine Compared with Intramuscular Epinephrine

Campbell, Ronna L.; Bellolio, M. Fernanda; Knutson, Benjamin D.; Bellamkonda, Venkatesh R.; Fedko, Martin G.; Nestler, David M.; Hess, Erik P.

doi:10.1016/j.jaip.2014.06.007

Cited by 173 publications

(143 citation statements)

References 17 publications

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“…20 Epinephrine, 0.3 mg IM, is 10 times safer than epinephrine given as an intravenous bolus. 34 Serious adverse effects of IM epinephrine are rare in children.…”

Section: Safety Of Epinephrinementioning

confidence: 99%

Epinephrine for First-aid Management of Anaphylaxis

2017

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Anaphylaxis is a severe, generalized allergic or hypersensitivity reaction that is rapid in onset and may cause death. Epinephrine (adrenaline) can be life-saving when administered as rapidly as possible once anaphylaxis is recognized. This clinical report from the American Academy of Pediatrics is an update of the 2007 clinical report on this topic. It provides information to help clinicians identify patients at risk of anaphylaxis and new information about epinephrine and epinephrine autoinjectors (EAs). The report also highlights the importance of patient and family education about the recognition and management of anaphylaxis in the community. Key points emphasized include the following: (1) validated clinical criteria are available to facilitate prompt diagnosis of anaphylaxis; (2) prompt intramuscular epinephrine injection in the mid-outer thigh reduces hospitalizations, morbidity, and mortality; (3) prescribing EAs facilitates timely epinephrine injection in community settings for patients with a history of anaphylaxis and, if specifi c circumstances warrant, for some high-risk patients who have not previously experienced anaphylaxis; (4) prescribing epinephrine for infants and young children weighing <15 kg, especially those who weigh 7.5 kg and under, currently presents a dilemma, because the lowest dose available in EAs, 0.15 mg, is a high dose for many infants and some young children; (5) effective management of anaphylaxis in the community requires a comprehensive approach involving children, families, preschools, schools, camps, and sports organizations; and (6) prevention of anaphylaxis recurrences involves confi rmation of the trigger, discussion of specifi c allergen avoidance, allergen immunotherapy (eg, with stinging insect venom, if relevant), and a written, personalized anaphylaxis emergency action plan; and (7) the management of anaphylaxis also involves education of children and supervising adults about anaphylaxis recognition and fi rst-aid treatment.

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“…20 Epinephrine, 0.3 mg IM, is 10 times safer than epinephrine given as an intravenous bolus. 34 Serious adverse effects of IM epinephrine are rare in children.…”

Section: Safety Of Epinephrinementioning

confidence: 99%

Epinephrine for First-aid Management of Anaphylaxis

2017

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“…Dois terços dos pediatras indicaram corretamente a via de administração. A aplicação intramuscular no vasto lateral da coxa é a via mais eficaz 9 e segura 16 . O risco de superdosagem e eventos cardiovasculares adversos é significativamente maior com a administração de adrenalina intravenosa 16 .…”

Section: Discussionunclassified

Conhecimento de pediatras que atuam em urgências e emergências sobre tratamento da anafilaxia

Faria

Fernandes

2018

ABCS Health Sci.

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resumo introdução: Anafilaxia é uma reação sistêmica grave, aguda e potencialmente fatal. Apresenta vários desencadeantes e mecanismos diferentes, entretanto, o tratamento agudo é igual em todos os casos. objetivo: Avaliar o conhecimento sobre tratamento da anafilaxia e choque anafilático (CA) de pediatras que atuam em setor de emergência pediátrica. métodos: Estudo transversal através da aplicação de questionário de múltiplas escolhas com 10 perguntas sobre tratamento da anafilaxia e CA. Foram convidados todos os pediatras do Pronto Socorro de um Hospital Público Pediátrico. resultados: Cinquenta entre 51 pediatras concordaram em participar do estudo. A média de acertos foi 6,32 com mediana de 7 (mínimo 2 e máximo 10). Houve reconhecimento adequado dos pediatras sobre a droga de escolha para iniciar o tratamento da anafilaxia e CA em 96% e 92%, respectivamente. Sobre a via de administração da adrenalina, a adequação das respostas foi de 64%. Em relação à dose de adrenalina, 70% identificaram corretamente, porém, o conhecimento sobre a dose máxima foi de 44%. Ao perguntar o intervalo para repetir a adrenalina, 38% responderam corretamente. Perguntou-se sobre terapias adjuvantes no tratamento do CA com 74% de acerto. Sobre a droga que previne a reação anafilática bifásica, 60% responderam corretamente. Quanto ao tempo de observação, 54% responderam o período adequado. O acerto sobre apresentações disponíveis de adrenalina autoinjetável foi de 40%. Conclusão: Houve dificuldade principalmente em reconhecer dose máxima, dose de adrenalina autoinjetável e tempo necessário para ser repetida, o que aumenta o risco de superdosagem e seus efeitos adversos.Palavras-chave: anafilaxia; epinefrina; pediatria; tratamento de emergência. AbstrACt introduction:Anaphylaxis is a severe, acute and potentially fatal systemic reaction. It presents several triggers and different mechanisms, however, the acute treatment is the same in all the cases. objective: To evaluate the knowledge about treatment of anaphylaxis and anaphylactic shock (AS) of pediatricians who works in the pediatric emergency sector. methods: Cross-sectional study through the use of a multiplechoice questionnaire with 10 questions about the treatment of anaphylaxis and AS. All the emergency room pediatricians of a general pediatric hospital were invited. results: Fifty of fifty-one pediatricians agreed to take part of the study. The mean of right answers was 6.32 and median of 7 (minimum 2 and maximum 10). There was an appropriate recognition about the drug of choice to initiate the treatment of anaphylaxis and AS in 96% and 92%, respectively. On the route of adrenaline administration, the adequacy of the answers was 64%. Regarding to adrenaline dose 70% were right, however the recognition of the maximum dose was 44%. When asked about the interval to repeat the adrenaline, 38% responded correctly. About adjuvant therapies to treat AS the score was 74% and 60% when questioned about the drug that prevents biphasic anaphylactic reaction. In relation to the observation...

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“…In a study by Campbell et al, 301 patients were treated with epinephrine therapy for anaphylaxis. [6] A total of four incidents of overdose were reported, all of which occurred when epinephrine was administered via the intravenous route. Apart from epinephrine therapy, the importance of glucocorticoid and antihistamine therapy in anaphylaxis should not be discounted.…”

Section: Discussionmentioning

confidence: 99%

A case of takotsubo cardiomyopathy in a patient with anaphylaxis treated with epinephrine

Thind

Patel

Patri

et al. 2017

CRIM

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Takotsubo cardiomyopathy (TTC) is a recently identified transient cardiomyopathy that is usually associated with emotional or physical stress. Catecholamine surge appears to be central to the mechanism of TTC. TTC in the setting of anaphylaxis is rare. We present a case of a 58-year-old female was referred from an outside hospital after being diagnosed with anaphylaxis. She received 0.3 mg epinephrine intramuscularly and 1 mg intravenously. Upon admission to our hospital, she was complaining of chest pain. EKG done in the outside hospital showed ST elevations in the anterior leads but the EKG done at our hospital was normal. She had to be intubated in view of impending airway obstruction. She was subsequently started on epinephrine infusion in the intensive care unit for hypotension. She was found to have elevated troponins that trended up. An echocardiogram performed on day 3 revealed a left ventricular ejection fraction of 25% and apical hypokinesis suggestive of TTC. Cardiac catheterization was initially deferred in view of a history of dye allergy. A nuclear stress test was done instead that revealed reversible ischemia in anteroseptal regions. Cardiac catheterization was performed eventually with pre-medication that showed a near-normal coronary circulation. A repeat echocardiogram performed 6 weeks after discharge showed normal systolic function.

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Epinephrine in Anaphylaxis: Higher Risk of Cardiovascular Complications and Overdose After Administration of Intravenous Bolus Epinephrine Compared with Intramuscular Epinephrine

Cited by 173 publications

References 17 publications

Epinephrine for First-aid Management of Anaphylaxis

Epinephrine for First-aid Management of Anaphylaxis

Conhecimento de pediatras que atuam em urgências e emergências sobre tratamento da anafilaxia

A case of takotsubo cardiomyopathy in a patient with anaphylaxis treated with epinephrine

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