Edema after antibiotics
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Sudden death after administration of antibiotics. / Goldstein SB. // Forensic-medical examination. - 1963. - №2. - P. 21-24.
In the early years of penicillin, heavyreactions were rare, and there were almost no cases of fatalities, and therefore the medicine was regarded as completely harmless. Until 1951, only one case with a fatal outcome was published [Alexander (Alexander)].
By now, the literature has accumulatedextensive material on the side effects of various antibiotics. It is established that they mainly cause allergic and toxic reactions. According to A. Askarov, Johnston, Johnston, Cuzrot, and others, penicillin causes an anaphylactic reaction, sometimes fatal, more often than other antibiotics. Toxic reactions are often observed with intralumbalnom introduction of antibiotics.
Australian Medical College collecteddata on 6832 patients treated with penicillin parenterally, of which 88 (1.3%). allergic reactions are noted, and in men it is 2 times more likely than in women; in 7 patients the reaction occurred immediately after the administration of the antibiotic.
Particular attention is paid to deathcases in the treatment of antibiotics. According to the World Health Organization in 1957, 70 000 patients treated with penicillin accounted for 1 fatal reaction. In Denmark, there is 1 death on 10 million injections. BA Grzhimolovsky quotes literature data on 70 deaths associated with the administration of antibiotics. Richet, Ducro and Delsant indicate that the fatal outcome may occur with an allergic shock such as anaphylactic and with allergic edema, which in some cases spreads to the larynx (Quincke's edema). The signs preceding the shock are dry mouth, shortness of breath, alternating redness and pallor of the face, sometimes urticaria rash, collapse and respiratory arrest. Quincke's edema is accompanied by a sudden edema of the face, lips, and eyelids, passing into the laryngeal edema with the development of acute asphyxia.
In this report, we cite cases of death after the administration of antibiotics, which we have observed for several years.
Patient A. 17, was taken to the hospital in extremely serious condition. 30 minutes earlier, in connection with the furuncle of the nose, he was injected with 100,000 units of penicillin (potassium salt), and a few minutes later the patient felt constricted in the chest and fell down, in the past he had a similar condition after the administration of antidiphtheria serum and inoculations against the abdominal typhus.On the examination it was found that the patient was rushing, asking for water, the questions answered with great difficulty, the eye gap closed, the pupils narrowed, the heart sounds deaf, tachycardia, cyanosis of the face and limbs. The condition progressively worsened, anuria occurred, the next day there were seizures, Cheyne-Stokes breathing, and about a day after the introduction of penicillin, death occurred. Pathological anatomy, ulcerative colitis, acute vasodilatation, pericellular and perivascular edema, point bleeding in the brain , on the surface of the heart, lungs, mucous membrane of the stomach and intestines, moderate pulmonary edema.Without forensic examination of the organs of toxic substances was not detected. It is concluded that the death came from anaphylactic shock in connection with the introduction of penicillin. In the history of hypersensitivity to drugs.
It is known that in some cases, hyperergica reaction in an organism sensitized by an allergen may occur when not only the same allergen is administered, but also another allergen (MA Skvortsov et al.). In the light of these data, one can also consider the mechanism of the development of an allergic reaction in patient A. who, following the introduction of penicillin, received anaphylactic shock, and then developed a hyperergic reaction accompanied by the appearance of ulcerative colitis with intestinal bleeding and sharp intoxication of the body.
Patient K. 45 years old, entered a lyupozorium for extensive tuberculous skin lesions. The general condition is good, there is some increase in cardiac dullness in the diameter, muffling of heart sounds, excessive deposition of subcutaneous fat. Intramuscular injection of 250 000 units of streptomycin was administered, after which in 5-6 minutes the patient felt constriction in the chest, general weakness, nausea; skin moist, cyanotic, there was a sharp swelling of the tongue, drooling, the pulse disappeared, breathing became barely perceptible. After 10 minutes, death occurred. Pathoanatomical diagnosis: sharp edema of the tongue, epiglottis, epiglottis-arytenoid fold, mucous membrane of the pear-shaped laryngeal depression (Quincke's edema); edema of the right lung; moderate edema and fullness of the soft meninges and brain substance, hemorrhage under the ependyma of the bottom of the fourth ventricle; hemorrhage under the pleura of the left lung; single hemorrhages under the epicardium, moderate expansion of the heart cavities, moderate atherosclerosis of the left coronary artery and aorta. According to the forensic expert, death came from anaphylactic shock, which developed as a result of the injection of streptomycin.
Gr-ka M. 64 years, became ill with pneumonia. At home, 100,000 units of penicillin was injected intramuscularly. A few minutes after the injection, death occurred.
According to anamnestic data, for the first timepenicillin was administered to the patient 5 years ago; then the patient after the injection complained of nausea. A month before the incident, she was injected with platyphylline, after which she fainted and was hardly able to get out of a serious condition. Pathoanatomical diagnosis: left-sided lower-lobe serous-hemorrhagic pneumonia; atherosclerosis with primary lesion of the coronary vessels of the heart; point spotted hemorrhages under the endocardium of the left ventricle, under the capsule of the liver; edema of the brain, mild cerebral membrane, vascular plexus, hyalinosis of cerebral vessels. It is concluded that the death came from anaphylactic shock in connection with the introduction of penicillin. In the history of hypersensitivity to drugs and antibiotics.
In girl K, 7 years old, temperature 38 °, rednessthroat, acetonuria. The next day the temperature is 37.7-38 °, the pharynx is slightly hyperemic, the amygdala is of medium size, the pulse is 100 beats per minute, the odor of acetone from the mouth. In the evening of the same day, under the general satisfactory condition of the patient (the temperature decreased, the child was active, watched the television program), 150,000 units of penicillin, 50,000 units of streptomycin were injected on a 0.5% solution of novocaine. A minute after the injection, she had a sharp pallor of her face, cyanotic lips, vomiting, convulsions, dyspnea; the pulse became threadlike. After 35-40 minutes, death occurred. Pathoanatomical diagnosis: hyperplastic tonsillitis; focal interstitial myocarditis mainly of a productive nature; edema of the larynx, brain and its soft membranes; foci of hemorrhage in the trunk of the brain and in the lungs; acute focal emphysema of the lungs. According to the forensic expert, death came from anaphylactic shock caused by the introduction of antibiotics. In the history of hypersensitivity to drugs.
From the history of development found that the girl is oftensuffered from catarrh of the upper respiratory tract and follicular angina, suffered diphtheria complicated by myocarditis, repeatedly received penicillin in tablets and intramuscularly. After taking streptocide and norsulfazole, there was vomiting. Diseases sometimes accompanied by acetonuria.
Patient S. 31, was hospitalized for focal pulmonary tuberculosis in the compaction stage, left-sided dry pleurisy, chronic hepatitis. In a relatively satisfactory state, 500,000 units of streptomycin were injected intramuscularly. Immediately after the injection, the face turned pale, lips became cyanotic, foam appeared from the mouth; the patient lost consciousness and died 3-4 minutes later. Pathoanatomical diagnosis: focal fibrous-casein tuberculosis of the lungs; swelling of the laryngeal mucosa; hemorrhage under the endocardium of the left ventricle of the heart; atherosclerosis of the aorta; fibrous adhesions in the pleural cavities. According to the forensic medical expert, the cause of death was anaphylactic shock caused by the injection of streptomycin.
Thus, in all the above observationsan allergic reaction occurred after the introduction of antibiotics. Three patients were administered penicillin, two - streptomycin and one - penicillin in a mixture with streptomycin. In the last 3 cases, that is, when streptomycin was used, the reaction manifested itself as a Quincke edema. According to X. Planeles and A. Kharitonova, Quincke's edema in most cases is observed after the application of penicillin. Parets described this syndrome after the administration of aureomycin.
In 4 of our observations, death occurred veryquickly (from 1-2 to 10 minutes) and in one - almost a day after the injection. At 3 patients in the anamnesis the raised sensitivity to chemotherapeutic preparations and medical whey is marked. Two patients were in hospitals, the rest were treated at home.
X. Planeles and A. Kharitonov is quoted in the statistical data of the American authors Wolchi, Lewis, and others published in 1958 concerning 827 hospitals with a total number of beds 198,333. It was established that for 3,3 years (from the end of 1953 to the beginning of 1957), 3,419 cases of heavy reactions caused by treatment with penicillin. Only in 793 cases it was anaphylactic reactions, of which 72 ended in the death of patients. In the opinion of H. Planeles and A. Kharitonova, "these, in fact, small figures, completely lose their significance in comparison with the huge number of seriously ill infectious diseases, to which the use of penicillin saved life."
At the same time, it would be erroneous not to take into accounttherapeutic practice the possibility of severe complications. Doctors sometimes prescribe penicillin, streptomycin and other antibiotics for diseases that are well cured by other medicinal substances. In our cases, for example, there was no reason to apply penicillin to patient A. with a nasal boil and normal temperature (no autopsies were found during autopsy). There was hardly a need to prescribe antibiotics and the girl K- with angina at a satisfactory condition of the patient and a decrease in temperature.