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When anaphylactic shock meets epinephrine and blood lactate increases: A case report.
- Source :
-
Medicine [Medicine (Baltimore)] 2024 Sep 06; Vol. 103 (36), pp. e39263. - Publication Year :
- 2024
-
Abstract
- Rationale: Anaphylactic shock, a severe and rapid systemic allergic reaction, poses significant treatment challenges. Epinephrine, the first-line treatment, effectively reverses symptoms but can complicate the clinical picture by elevating lactate levels, blurring the distinction between shock-induced hypoperfusion and drug-induced metabolic effects.<br />Patient Concerns: A 26-year-old female presented with anaphylactic shock following an antibiotic infusion, experiencing chest tightness, hypotension, and pulmonary edema, without significant past medical history apart from a noted allergy to fish and shrimp.<br />Diagnoses: Anaphylaxis was diagnosed based on clinical presentation and supported by imaging that revealed pulmonary edema, despite normal troponin levels and electrocardiogram.<br />Interventions: Treatment included 0.5 mg of intramuscular epinephrine and 5 mg of intravenous dexamethasone, with subsequent intubation and mechanical ventilation in the intensive care unit. An intravenous epinephrine infusion was also administered for hemodynamic support.<br />Outcomes: While epinephrine resolved the pulmonary edema and stabilized circulation, it led to a significant, albeit transient, increase in lactate levels, which normalized following discontinuation of epinephrine, indicating the metabolic effect of the drug rather than ongoing tissue hypoperfusion.<br />Lessons: This case illustrates the importance of recognizing epinephrine-induced lactate elevation in anaphylactic shock, necessitating a nuanced interpretation of lactate dynamics. Clinicians must differentiate between lactate elevations due to tissue hypoperfusion and those arising from epinephrine's pharmacologic effects to optimize patient care.<br />Competing Interests: The authors have no funding and conflicts of interest to disclose.<br /> (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Subjects :
- Humans
Female
Adult
Dexamethasone therapeutic use
Dexamethasone administration & dosage
Pulmonary Edema chemically induced
Pulmonary Edema drug therapy
Anti-Bacterial Agents adverse effects
Anti-Bacterial Agents administration & dosage
Anaphylaxis drug therapy
Anaphylaxis blood
Epinephrine administration & dosage
Lactic Acid blood
Subjects
Details
- Language :
- English
- ISSN :
- 1536-5964
- Volume :
- 103
- Issue :
- 36
- Database :
- MEDLINE
- Journal :
- Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 39252252
- Full Text :
- https://doi.org/10.1097/MD.0000000000039263