Angioedema, anaphylactic shock
Anaphylactic shock is pronouncedmanifestation of anaphylaxis. It is an acutely developing, life-threatening syndrome affecting vital organs and systems. Anaphylactic shock is recorded in 4.4% of patients with anaphylaxis .
Clinical picture in anaphylactic shockis diverse, which is due to the defeat of a number of organs and body systems. As a rule, the initial reaction is manifested by pricking and itching of the skin of the face, hands. Then, the heat in the whole body joins, the feeling of the opening of the head, numbness of the extremities, and the rapidly growing weakness.
In the case of mild to moderate forms of allergy, urticaria is observed; with lightning-fast forms of anaphylactic shock, it simply does not have time to develop .
Other symptoms include rhinitis,conjunctivitis, angioedema, abdominal pain, vomiting, diarrhea, and a feeling of near death. Patients experiencing difficulty in breathing (due to edema of the larynx and bronchospasm), pain behind the sternum (due to myocardial ischemia with arterial hypotension). With a loss of consciousness, it is possible to develop a convulsive syndrome.
The prevalent hemodynamic disorders areperipheral vasodilation and hypovolemia . The latter occurs mainly as a result of increased permeability of the capillaries, which leads to the escape of fluid from the vascular bed. The main causes of death are asphyxia and hemodynamic disorders.
Anaphylactic shock, symptoms [7, 24]
Skin and mucous membranes - 90%
Digestive system - 25-30%
Abdominal crisis: abdominal pain, nausea, vomiting, diarrhea,
bloating, metallic taste in the mouth
Symptoms usually develop after a few minutes from the onset of the causative agent and reach a peak within 1 hour. The way in which the causative agent enters is playeda certain role. The most dangerous are intravenous injections, because with intravenous anaphylactogen, the symptoms develop more rapidly, usually within 3 minutes [17, 24].
The shorter the interval from the moment of anaphylactogen to the body and before the onset of an anaphylactic reaction, the more severe the clinical picture. The greatest percentage of deaths anaphylactic shock gives after developing it 10-15 minutes after contact with anaphylactogen [10, 11].
Sometimes the symptoms appear after a few hours, which is usually the case with allergies to foods and latex [4, 8].
In 5% of patients, there is a two-phase anaphylaxis when the symptoms recur after 4-8 hours or 12-24 hours . Hence the requirement of compulsory hospitalization for observation.
Anaphylactic shock is more severe in patients,long-term beta-blockers (for example, for IHD), and patients with bronchial asthma [24, 6]. This phenomenon is explained by a reduced catecholamine response . In such cases adrenaline is not used, and as an inotropic agent, 1 mg of glucagon (1 ampoule) is injected intravenously, then drip at a rate of up to 1 mg / h.
It should be noted the absence of dependenceanaphylaxis from a dose. In the literature, cases of the development of anaphylactic shock in patients with an allergy to penicillin after a nurse approached them, made an injection of penicillin before the other patient .
Response of reaction and wide rangesymptoms can cause diagnostic difficulties. Anamnestic information about previous anaphylactic reactions is extremely important. It is necessary in each case to conduct a complete physical examination as far as possible. Assess the condition of the skin and upper respiratory tract, measure heart rate and blood pressure, perform auscultation of the lungs. It is desirable to conduct peak flowmetry, pulse oximetry.
Assume another reason is only after the exclusion of anaphylaxis, tk. the delay in arresting the anaphylactic reaction can be fatal.
Medicinal angioedema. One of the side effects of inhibitorsangiotensin-converting enzyme is an angioedema of the upper respiratory tract. This unwanted reaction can occur at any time and has nothing to do with the duration of the drug. Effective treatment for this form of angioedema has not been developed, early diagnosis and restoration of airway patency are important .
Hereditary angioedema is a family disease and is clinically indistinguishable from anaphylactic or medicinal angioedema. An important differential diagnostic feature is the absence of hives.
Attack of bronchial asthma manifested bronchospasm and stridor, which also occur in anaphylactic reaction. However, an attack of asthma is usually not accompanied by urticaria or angioedema.
In rare cases panic attacks can be manifested by functional stridor as a result of dysfunction of the vocal cords. As with asthma, there is no hives, angioedema or arterial hypotension.
Syndrome of "Chinese restaurant" develops 2-10 minutes after consumptionfood products rich in sodium glutamate. Patients complain of pain in the chest, palpitations, burning of the face and back of the neck, transient hyperemia of the skin, sweating, dizziness, headache, nausea and vomiting, with asthma, bronchospasm is possible. Mechanisms for the development of the "Chinese restaurant" syndrome have not been studied enough. It is suggested that sodium glutamate causes a transient increase in the concentration of acetylcholine. Unlike anaphylaxis, patients have no hemodynamic disorders (arterial hypotension).
Scobroidosis characterized by cardiovascular (arterialhypotension, tachycardia), gastrointestinal (nausea, vomiting, diarrhea), skin (urticaria, angioneurotic edema, erythema) syndromes. The reason is the increase of histamine in fish (tuna, mackerel, etc.) In violation of its storage conditions resulting from bacterial contamination. The duration of the disease, as a rule, is several hours, less often days. After the transferred or carried disease longly a hyperemia of a skin is saved. Unlike anaphylactic shock, scomboidosis develops in several people who consume fish. The concentration of mast cell tryptase in the blood is within the normal range.
Anaphylactic shock is also necessarydifferentiate from all the urgent conditions that can occur with arterial hypotension - heart attack (heart attack, arrhythmia), ectopic pregnancy (with a collapoid state in combination with sharp pains in the abdomen), fainting, etc. With all these conditions, there is no hives or angioedema.
File Contents Anaphylactic shock
• Anaphylactic shock. Symptoms and differential diagnosis.