Successful treatment of severe anaphylactic shock with vasopressin. Two case reports.
Severe anaphylactic shock is a life-threatening situation that needs immediate treatment of progressive hemodynamic failure. We report two cases of severe anaphylactic shock treated with arginine-vasopressin (AVP): In a 42-year-old male patient anaphylactic shock was caused by the sting of a hornet. At the scene, he was found unconscious, cyanotic, with a heart rate of 130/min without measurable blood pressure. The patient was intubated and ventilated with 100% oxygen, intravenous epinephrine (1 mg over 2 min) had no effect on blood pressure. After injection of 10 IU vasopressin, followed by infusion of 40 IU vasopressin, hemodynamics could be stabilized at once. In the second case, a 47-year-old male patient was stung by a wasp. At the scene he was unconscious, blood pressure was not measurable, heart rate was 140/min. The patient was treated with 40 IU vasopressin followed by rapid infusion of 500 ml NaCl 0.9%. After injection of vasopressin, blood pressure raised to 80/50 mm Hg and heart rate decreased to 90/min. Both patients needed ventilator therapy for several days and recovered fully.
Kill
Clemens
C
Department of Anaesthesiology and Critical Care, Philipps University, Marburg, Germany. killc@mailer.uni-marburg.de
Wranze
Erich
E
Wulf
Hinnerk
H
D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy* / Q000209:etiology; D000818:Animals; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D006801:Humans; D007299:Insect Bites and Stings / Q000150:complications*; D008297:Male; D008875:Middle Aged; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014863:Wasps
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin