Use of enoximone in management of anaphylaxis complicated by labetalol use.
A 42-year-old woman with end-stage renal failure was admitted to the intensive care unit following resuscitation from a pulseless electrical activity cardiac arrest after intravenous piperacillin/tazobactam. Persistent bradycardia and hypotension, unresponsive to epinephrine and norepinephrine, were suspected to have been exacerbated by chronic labetalol therapy for resistant arterial hypertension. As an alternative, the non-adrenergic inotrope, enoximone, was started. This, combined with thrombolysis for possible pulmonary embolism, heralded significant haemodynamic improvement, allowing weaning from inotropic support. A clear CT pulmonary angiogram 2 days post-arrest and significantly raised mast cell tryptase levels confirmed anaphylaxis rather than pulmonary embolism as the precipitating cause. We believe this to be the first case report of phosphodiesterase-III inhibitor use in the management of anaphylaxis complicated by α/β-blockade, and discuss the mechanism behind this effect and comparison with the more commonly reported use of glucagon.
John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Sophie
S
Hayhoe
John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Vilas
V
Navapurkar
John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.
Andrew
A
Conway Morris
D000328:Adult; D000707:Anaphylaxis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D017335:Enoximone / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology; D007741:Labetalol / Q000627:therapeutic use*; D058987:Phosphodiesterase 3 Inhibitors / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D058987:Phosphodiesterase 3 Inhibitors; D017335:Enoximone; D007741:Labetalol