Diagnostic Dilemma in Allergy and Coronary Syndromes: Kounis Syndrome or Adrenaline Effect?
Journal Title: Çocuk Acil ve Çocuk Yoğun Bakım Dergisi - Year 2018, Vol 5, Issue 1
Abstract
Management of anaphylaxis includes adrenaline, a life-saving drug, however appropriate dosing and administration are of crucial importance due to serious side effects. We present a 15-year-old female with anaphylactic reaction manifesting as acute coronary syndrome and pulmonary edema following the administration of adrenaline as an intravenous bolus. Focusing on anaphylaxis, adrenaline and coronary symptoms, this report discussed the interactions between three intertwining entities: Kounis syndrome, Takotsubo cardiomyopathy, and adrenaline-induced coronary vasospasm, and challenges in differential diagnosis. Brugada syndrome (cardiac autonomic dysfunction) and clinical manifestation of the patient was also evaluated. Early consideration of adrenaline at the appropriate dose and administration route is essential in anaphylaxis management. Kounis syndrome should be considered in those presenting with allergy symptoms and chest pain and adrenaline should be used carefully due to possible risks of worsening coronary symptoms in patients with Kounis syndrome. This report also highlights a very rare side effect of adrenaline; the drug, which constitutes the cornerstone of anaphylaxis management, has a potential to trigger allergy itself due to metabisulfite-containing preservative.
Authors and Affiliations
Ebru Atike Ongun, Nilgün Erkek, Fırat Kardelen, Ayşen Bingöl, Oğuz Dursun
Keywords
Related Articles
- EP ID EP379129
- DOI 10.4274/cayd.83097
- Views 129
- Downloads 0
A Case of Pyridoxine Dependent Epilepsy Presented with Status Epilepticus
Pyridoxine-dependent epilepsy (PDE) is a rare autosomal recessive encephalopathy due to mutations in the ALDH7A1 gene. Intractable seizures are the most frequent clinical form in the early infantile period. A case of a 4...
Point-of-Care Ultrasound as a Diagnostic Tool for Nutcracker Syndrome in Pediatric Emergency Department
Abdominal pain is one of the most common causes of admission to pediatric emergency department. Point-of care ultrasonography combined with appropriate history and physical examination provides rapid and accurate managem...
Aluminium Phosphide Poisoning: Two Pediatric Patients and Two Different Clinical Outcomes
Aluminium phosphide is an insecticide that turns into a quite toxic gas called phosphine when contacts with gastric fluids. Aluminium phosphide poisoning causes severe metabolic acidosis, acute respiratory distress syndr...
Bonzai Unusual Effects: A Case Report
The use of synthetic cannabinoids is a major health problem in all over the world as well as in our country. These products are synthetic substances created via mixture of cannabinoids and various plants. They are easy t...
Procedural Sedation for Orthopedic Fracture Reductions in the Pediatric Emergency Department
To provide an updated literature review on pediatric procedural sedation in the emergency department. Discuss patient evaluation, monitoring, indications, and contraindications of common pharmacologic agents used for pro...