Division of Pediatric Critical Care, Children's Hospital of Illinois, Peoria, IL, USA.
Division of Pediatric Cardiology, Children's Hospital of Illinois, Peoria, IL, USA.
Am J Case Rep. 2020 May 29;21:e922120. doi: 10.12659/AJCR.922120.
BACKGROUND Epinephrine for anaphylactic shock is the standard life-saving treatment in the emergency department. Cardiac symptoms after epinephrine administration in a child with no prior cardiac history are often not suspected. We describe a presentation of diastolic cardiac dysfunction after anaphylaxis from a bee sting in an adolescent male. CASE REPORT A 16-year-old male with no prior history of allergy presented with anaphylaxis following a bee sting. The patient received an inadvertent intravenous rather than intramuscular dose of 1: 1000 epinephrine, leading to myocardial ischemia. Diastolic dysfunction resulting from myocardial ischemia and fluid resuscitation led to development of pulmonary edema. The patient required epinephrine drip for hemodynamic support and BiPAP for respiratory support. CONCLUSIONS This case highlights the risk of giving a rapid intravenous push of epinephrine, which converted an anaphylactic reaction to cardiogenic shock. Anaphylaxis-related coronary ischemia (Kounis) syndrome is another less likely etiology for our patient's presentation.
在急诊科，肾上腺素是治疗过敏性休克的标准救命治疗方法。在没有既往心脏病史的儿童中，肾上腺素给药后的心脏症状通常不会被怀疑。我们描述了一例青少年男性因蜜蜂蜇伤后出现过敏性休克导致舒张性心脏功能障碍的表现。
一名 16 岁男性，无过敏史，在被蜜蜂蜇伤后出现过敏反应。患者意外接受了静脉而非肌肉注射 1:1000 的肾上腺素，导致心肌缺血。心肌缺血和液体复苏导致的舒张功能障碍导致肺水肿的发生。患者需要肾上腺素滴注以维持血流动力学，需要 BiPAP 以维持呼吸功能。
本病例强调了快速静脉推注肾上腺素的风险，这将过敏性反应转化为心源性休克。过敏性休克相关的冠状动脉缺血（Kounis）综合征是导致该患者出现这种情况的另一种不太可能的病因。
