R S Anupama, Nk Rohan Krishna, Mekkoth Sathya Lakshmi, Sridhara N, K Shivaraj
Emergency Medicine, Fortis International Hospital Rajajinagar, Bengaluru, IND.
General Practice, Fortis International Hospital Rajajinagar, Bengaluru, IND.
Cureus. 2025 Jul 24;17(7):e88683. doi: 10.7759/cureus.88683. eCollection 2025 Jul.
Anaphylaxis is a severe, rapidly progressing hypersensitivity reaction that requires prompt recognition and administration of intramuscular epinephrine. While guidelines recommend fixed-dose intramuscular epinephrine regardless of heart rate or blood pressure, there are situations where this approach may carry risks. We present the case of a 27-year-old patient with no prior comorbidities, including asthma, allergies, or cardiovascular conditions, who developed sudden breathlessness, generalized urticaria, and swelling of the face and lips shortly after taking oral cefpodoxime, a third-generation cephalosporin, prescribed for a febrile illness at a local hospital. On arrival at our hospital, the patient was conscious and alert, with an oxygen saturation of 87% on room air, a heart rate of 169 beats per minute, and a blood pressure of 100/60 mmHg. The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) protocol was followed, and supportive care including oxygen, nebulized bronchodilators, and intravenous fluids was provided. Given the clear signs of anaphylaxis with marked tachycardia but no hypotension, there was a dilemma regarding the administration of standard intramuscular epinephrine due to concerns about worsening tachyarrhythmias. Under close monitoring, carefully titrated microdosed intravenous epinephrine was administered using a dilution protocol, resulting in rapid symptom improvement without cardiovascular instability. The patient was admitted to the intensive care unit for monitoring and supportive care and was later discharged in stable condition with oral antihistamines, corticosteroids, and clear instructions on allergen avoidance to prevent future emergencies. This case illustrates the need for clinical judgment when strict adherence to guidelines may pose a risk and demonstrates the role of individualized microdosed intravenous epinephrine in managing anaphylaxis in patients with significant tachycardia and normotension.
过敏反应是一种严重的、迅速进展的超敏反应，需要迅速识别并给予肌内注射肾上腺素。虽然指南推荐无论心率或血压如何均使用固定剂量的肌内注射肾上腺素，但在某些情况下这种方法可能存在风险。我们报告一例27岁患者，既往无合并症，包括哮喘、过敏或心血管疾病，在当地医院因发热性疾病服用第三代头孢菌素口服头孢泊肟后不久，突然出现呼吸急促、全身性荨麻疹以及面部和嘴唇肿胀。到达我院时，患者意识清醒，在室内空气中氧饱和度为87%，心率169次/分钟，血压100/60 mmHg。遵循ABCDE（气道、呼吸、循环、残疾、暴露）方案，并提供了包括吸氧、雾化支气管扩张剂和静脉输液在内的支持性治疗。鉴于有明显的过敏反应迹象且伴有显著心动过速但无低血压，由于担心会使快速性心律失常恶化，在给予标准肌内注射肾上腺素方面存在两难境地。在密切监测下，使用稀释方案小心滴定给予小剂量静脉注射肾上腺素，症状迅速改善且未出现心血管不稳定。患者被收入重症监护病房进行监测和支持性治疗，后来口服抗组胺药、皮质类固醇并得到关于避免接触过敏原以防未来紧急情况的明确指示后，病情稳定出院。该病例说明，在严格遵循指南可能带来风险时需要临床判断，并证明了个体化小剂量静脉注射肾上腺素在治疗有显著心动过速和血压正常的过敏反应患者中的作用。
