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When anaphylactic shock meets epinephrine and blood lactate increases: A case report.

Authors :
Zhang ZR
Shen YY
Yi RQ
Feng W
Chen W
Li CE
Fan ZK
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.)

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