The pivotal role of vasopressin in refractory anaphylactic shock.
BACKGROUND
Severe anaphylaxis can be associated with cardiovascular collapse that is difficult to manage and does not respond to treatment with epinephrine. Because anaphylaxis is uncommon, unpredictable and may be fatal, a prospective, randomized, controlled trial in humans on the best management is difficult and guidelines are based on theory and anecdotes only.


RESULTS
We report six cases in which the use of vasopressin was successful in the treatment of anaphylactic shock.


CONCLUSIONS
Standard treatment of anaphylactic shock, including discontinuation of the causative agent, administration of epinephrine, and infusion of IV fluids, did not stabilize cardiocirculatory function, and adding arginine vasopressors resulted in prompt hemodynamic stabilization.
Schummer
Claudia
C
Department for Anesthesiology and Intensive Care Medicine, SRH Zentralklinikum Suhl, Albert-Schweitzer str. 2, 98527 Suhl, Germany. cwsm.schummer@gmx.de
Wirsing
Melanie
M
Schummer
Wolfram
W
D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced / Q000188:drug therapy*; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine