Paracetamol overdose – part 2

Clinical Pharmacology and Toxicology

Continued from previous question.

You assess the patient and correctly identify that she is suffering from anaphylaxis. What is the initial treatment of choice following oxygen/ ABC approach? (IV=intravenous IM =intramuscular)

  • Adrenaline IV
  • Adrenaline IM
  • Hydrocortisone IV
  • Hydrocortisone IM
  • Chlorphenamine IV

Adrenaline IM.

This is important!

It’s anaphylaxis adrenaline is give IM e.g. upper outer quadrant of the thigh.

In anaphylaxis IV adrenaline is not safe for use by practitioners not experienced in its use in extreme conditions. It should only be given by practitioners experienced in its use in a closely monitored environment (e.g. ITU).

IV adrenaline is used in cardiac arrests for a number of indications and this should not be confused when dealing with a conscious patient with anaphylaxis.

Hydrocortisone and chlorphenamine are both important adjuncts but the fast acting treatment of choice is adrenaline. IV hydrocortisone will take >30 minutes to have any appreciable clinical effect.