Tonight, around 8:30 pm, I was reading the chart in the department when suddenly, a patient had an infusion reaction: chills, fever, headache, nausea, and vomiting. After the physician on duty gave dexamethasone 10 mg sedation and finasteride 25 intramuscular, the patient gradually returned to normal within an hour or so.
The nurse, after handling the patient, asked me if this should be an infusion reaction or a drug reaction. I was stunned, and I understood in my heart that this was an infusion reaction, so I told the nurse that it was more like a drug reaction, because infusion reactions occur when there is contamination in the process of dispensing or when there is a quality problem with the drug itself, is that so? Zhang Jiankui, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
I went back to the dormitory to check the Internet and realized that the nurse and I did not have a comprehensive understanding of the concept of infusion reaction. The common clinical infusion reactions are pyogenic reactions and drug allergic reactions, and both of them have similar clinical symptoms, and both can appear chills, fever, headache, nausea, vomiting, palpitations, chest tightness, hypotensive shock, etc. The reaction of the patient encountered in the department should be pyogenic reaction. The distinction between the two is now briefly described as follows.
The main manifestation of pyogenic reaction is the sudden appearance of chills, chills, pale face and cold limbs during or after infusion, followed by hyperthermia with body temperature up to 40℃ or more, and in severe cases, accompanied by nausea, vomiting, headache, arthralgia of limbs, grayish skin, drop in blood pressure, shock or even death. It usually occurs about 20 min after the start of infusion, but also occurs within 2-4 h, and usually lasts about 0.5-1 h.
Once the pyrogenic reaction occurs, immediately stop the infusion, but do not remove the infusion needle or catheter, immediately replace the infusion device, give dexamethasone 5-10mg intravenously or sedation, or apply hydrocortisone 100-200mg sedation, or give benadryl, chlorpheniramine (paracetamol) intramuscular injection. Those with respiratory distress should be given oxygen, those with agitation can be given sedatives, those with chills should be kept warm, those with high fever should be treated with physical cooling or antipyretics. It has been described that scopolamine (654-2) is an effective therapeutic drug, and intravenous application of 20-30 mg can rapidly relieve the pyrogenic reaction, and its therapeutic mechanism is to improve microcirculation, relieve tissue hypoxia, and also facilitate the clearance of pyrogen.
The manifestations of drug-induced allergic reactions are complex and varied, different drugs can cause different reactions, and the same drug acting on different individuals can also produce different manifestations. The typical manifestations of type I allergic reactions are urticaria, bronchial asthma, angioedema and anaphylaxis, among which anaphylaxis is the most dangerous allergic reaction, with rapid onset, 50% occurring within 5 min after drug administration, and untimely resuscitation can be life-threatening, and patients can simultaneously develop respiratory obstruction, manifestations such as laryngeal edema and bronchospasm; circulatory failure manifestations such as cold extremities and decreased blood pressure. Central nervous system hypoxia manifestations such as headache, irritability, and even impaired consciousness. Type II allergic reactions are commonly manifested as hemolytic reactions. Type III allergic reactions are mostly manifested as serum sickness-like reactions, with swollen lymph nodes, joint edema, bronchospasm, etc. Type IV allergic reactions are generally manifested as inflammatory reactions, such as contact dermatitis, allergic encephalitis, allogeneic tissue rejection and rash, etc.
Treatment: Mild cases can improve rapidly with the application of antihistamines or hormone therapy. For severe allergy, especially anaphylaxis, immediate resuscitation should be performed, and the resuscitation measures are.
① Immediately stop using the drug that caused the allergic reaction.
② immediately give 1:1000 epinephrine 0.5ml intramuscular injection or add 5% glucose injection diluted 10 times slowly intravenous injection, if not relieved, can be repeated after 15-30 min to the condition relief.
③Apply adrenocorticotropic hormone: e.g., give hydrocortisone 100-200 mg or dexamethasone 5-10 mg into 5% glucose injection 40 ml intravenously, and if necessary, repeat the injection after 1 to 3 h.
④Dilate and give vasoactive drugs: methotrexate 50-100 mg in 5% glucose injection intravenously, if necessary, combined with dopamine.
⑤Antihistamines: Isoprostanes 25-50 mg intramuscularly.
⑥10% calcium gluconate 10-20 ml slowly injected intravenously.
⑦Keep the airway open, administer oxygen, and perform tracheal intubation for artificial respiration if necessary.
Through comparison, the characteristics of the difference between pyrogenic reactions and drug allergic reactions can be clearly understood, and it is hoped that clinical workers can correctly identify the event when they encounter infusion reactions and take corresponding measures in a timely manner.
Attachment: points of differentiation between drug allergic reactions and pyrogenic reactions.
Pyrogenic reactions Allergic reactions
Pathogenic factors Pyrogen (endotoxin) Drug itself
Endotoxin acts on the thermoregulatory center and sensitizes the body after the first exposure to a drug, and causes allergic reaction when exposed to the same drug again.
Allergic constitution Unrelated Closely related
Occurs in groups, mainly related to individual factors, but not in groups
Clinical manifestations Chills and hyperthermia Fever may be present, but the body temperature is usually relatively low and is not accompanied by chills
Rash is not usually present Rash is common
Shock may occur in severe cases, but it is rare Shock (without other allergic symptoms) is a type I allergic reaction
Bronchospasm and laryngeal edema are not usually present Bronchospasm and laryngeal edema are often present
Pyrogen test Mostly positive Negative