ANAPHYLAXIS IS SUSPECTED when there is dysfunction in ≥2 organ systems after exposure
to a suspected antigen.
1
Findings may include urticaria, mucosal edema, gastrointestinal distress, bronchospasm,
or hypotension. It also can be diagnosed in adults who have a sudden decrease in systolic
blood pressure to <90 mmHg or a ≥30% decrease from baseline blood pressure after exposure
to a known allergen. An elevated serum tryptase concentration helps to confirm the
diagnosis, as it is a marker for mast cell degranulation.
2
However, in patients with end-stage renal disease (ESRD), tryptase has been shown
to be elevated at baseline, which confounds the diagnosis of anaphylaxis.
3
In the perioperative setting, there are numerous possible triggers for allergic reactions
and anaphylaxis, including neuromuscular blocking agents, antibiotics, blood products,
chlorhexidine, and latex.
4
The first-line treatment for anaphylaxis is epinephrine, a proven life-saving intervention.
5
Herein, the authors describe the usefulness and importance of 2-dimensional echocardiography
in altering the management of an adult patient undergoing renal transplant surgery
experiencing anaphylaxis resulting from antibiotic administration. Echocardiography
revealed significant left ventricular outflow tract (LVOT) obstruction as the etiology
of worsening hemodynamic collapse refractory to epinephrine administration. This finding
prompted the institution of appropriate measures to treat concomitant anaphylaxis
and dynamic LVOT obstruction, resulting in full patient recovery.Key Words
Abbreviation:
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References
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Published online: December 23, 2022
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