Did anyone experience patient with life threatening reaction very shortly after IV ceftriaxone?? although it is not the first dose for young adult known sickle cell disease??
Yes, once. The patient developed a rash and swelling that was quickly reversed with IV Benadryl 50mg, dexamethasone 4mg IV, and famotadine 20mg IV. The patient was placed on a different antibiotic and suffered no further issues.
Was the patient in question allergic to Penicillin? Ceftriaxone can cause rare anaphalaxis in about 10% of patients who have a known PCN allergy. As a nurse, if I know the patient is allergic to PCN, I will administer the ceftriaxone if the doctor orders it, but I monitor them a bit more carefully for a potential reaction.
It's not usually the first dose that gets you. It's the second or third. With the first dose the patient just begins building antibodies but there aren't enough for the immune system to go into over drive. It's the subsequent doses that do that.
I'm not sure sickle cell has anything to do with this. That's a hemolytic disorder (a disease of the red blood cells) not an issue with the immune response system.
Yes
We have 10 patients , at least, in Jahrom university hospitals.
In Iran we have a center for drug complication data gathering about drug complication (ADR).in 2007-2009 every year ADR center, announced healthcare personnel about reaction to ceftriaxone.
do you know that we have any standard about iv shot infusion for ceftriaxon?
its very importanat
Can you tell me about those 10 cases please. We have 14 y sickler was very normal when he recived 2gm iv ceftriaxone after 10min direct cardiac arrest ..directly resustated and to icu for 10 hours refractory shock with max doses of 3 inotropes..2nd cardiac arrest with acidosis and expired.
I'm getting a bit outside my scope here, Dr. Ahmed, but I'm very interested by the case you relate.
If you don't mind my asking, why did the patient get such a high dose? Typically, I see physicians order 500mg for STDs, and 1gm for broad spectrum coverage for other infections.
What kind of infection did you supsect, and was he septic?
I looked up the drug and was interested to see it is known to cause hemolysis and hypoprothrombinema. What was the CBC like? If he had a reaction like that in combination with sickle cell anemia, it seems like the perfusion issues it could create would be catastrophic, to say the least. Is it a possibility that could have been the culprit with this patient?
Thank you for being interested Amy, you ask very good questions.
mostly he received it in the ward because of suspected osteomyelitis/ sepsis mostly as he had hip pain waiting for MRI to be done but unfortunately he didnt.
the dose issue , you are right as he was 40s KG but the overdose, do it explain the whole scenario?? and he had sort of hemolysis, drop in hemoglobin but this could happen in many situations I think.
I was thinking a catastrophic cascade from the hemolysis and lack of perfusion, and I overlooked your report that the patient arrested 10 minutes after administration.
It's the quick cardiac arrest that's puzzling. If I were giving this drug IM I would mix it with 1% Lidocaine, but I would never do that if I were giving it IV, which is what you originally reported.
So I looked at the literature again. I found a couple of references on PubMed that might be of interest to you:
http://www.ncbi.nlm.nih.gov/pubmed/21855259
http://www.ncbi.nlm.nih.gov/pubmed/22122488
In the first link, the authors describe a case very similar to yours, excepting the sickle cell crisis. The patient survived.
In the second link, the speed of administration seems to have been a factor. Too rapid administration was linked as a causal factor in some of the cases.
I don't know how your nurses administered this drug; here in the US it is usually given by IV piggyback infusion over 30 minutes. However, sometimes the physician will order it given by direct IV push. The dose is diluted with normal saline; the instructions that come with the vial for reconstitution will give a 1 gram dose diluted with saline 9.6 ml that is pushed over about 5 minutes. Pretty much the IV push method is used in home health and hospice health. I almost never see it in the hospital anymore; IVPB is so much safer.
I hope this helps, maybe it will give you a place to start in the literature. At least you know you're not the only doctor to run into this. Unfortunately, the articles themselves are behind a paywall, so I can't supply you with copies.
i have. within five minutes given as an iv drug, the patient developed a hypersensitivity reaction with the tongue enlarged and the infusion site (dorsum of the hand) developing a rash with edema. patient died shortly after with the autopsy results of acute chest syndrome.
thank you Samel..this is very sad to happen..
But Acute chest syndrome?? the patient was sickle cell anemia ??
I have after iv fast infusion the patient has syncope and tachycardia ..
- Badges
- Science topic