title: Complete recovery from prolonged cardio-pulmonary resuscitation following anaphylactic reaction to readministered intravenous cefazolin.
abstract: We describe a patient who developed a type I anaphylactic reaction to intravenous cefazolin. The patient had no known drug allergies and had previously received intraoperative intravenous cefazolin 2 months prior without any problems. Forty-fives after receiving cefazolin 1 g i.v. and while fully awake, the patient experienced shortness of breath, became unconscious, and then suffered a cardiac arrest. Resuscitation included endotracheal intubation, external cardiac compression, electrical defibrillation and multiple large doses of epinephrine, atropine, and sodium bicarbonate over the course of 2.5 h and three cardiac arrests. Nevertheless, the patient fully recovered. The intent of this case report is to address widely held concerns regarding cross-reactivity of cephalosporin, particularly cefazolin, to penicillin, the legitimacy of test dosing as a means to safely identify patients who will have an allergic reaction to cephalosporins and comment on patient-related predictors of survival following cardiopulmonary resuscitation and the good outcome in this case.
authors.affiliation: Department of Anesthesiology, University of California, San Diego, CA 92103-8770, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Gibbs
authors.forename: K M
authors.initials: KM
authors.lastname: Kuczkowski
authors.forename: J L
authors.initials: JL
authors.lastname: Benumof
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000503:physiopathology* / Q000628:therapy*; D002437:Cefazolin / Q000009:adverse effects*; D002511:Cephalosporins / Q000009:adverse effects*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004342:Drug Hypersensitivity / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications
chemical_list: D002511:Cephalosporins; D002437:Cefazolin