Anaphylaxis (anaphylactic Shock)

Clinical Description

It requires prompt treatment for laryngeal oedema, bronchospasm, and hypotension

It is most precipitated by:

• Drugs (antibiotics, NSAIDs)
• Insect stings (especially wasps and bees)
• Blood products and blood transfusions
• Certain foods e.g., eggs, cow's milk, nuts

General Measures:

• Adrenaline IM is a priority
• Determine and remove cause

Treatment

• Give Adrenaline 0.01 mg/kg IM anterior lateral thigh with max dose (0.5mg is max dose).
• Repeat as required (several times if necessary) every 10 minutes according to BP and pulse until improvement occurs
• Give Normal Saline 20 ml/kg by IV as a bolus
• Give Promethazine 25-50 mg by deep IM or, in emergencies, slow IV, as a solution containing 2.5 mg/ml in water for injection
• Promethazine should be repeated q8h. It is given after adrenaline and continued for 24-48 hours to prevent relapse.
• Steroids should also be given after initial treatment with adrenaline to prevent further deterioration

Adults

• Give Hydrocortisone 200 mg by slow IV push q6h for 24-48 hours
• When hydrocortisone not available Prednisolone may be used at 1mg/kg PO with max dose 60 mg q24h for 3 days
• Monitor pulse, BP, bronchospasm, and general response/condition every few minutes
• If there is continuing deterioration or no improvement the following may be necessary:
• Give NEBULISED SALBUTAMOL as for asthma if bronchospasm persists (see Section 16.2.1)
• Ventilation and/or tracheotomy if laryngeal oedema severe