Case of death due to anaphylactic shock after use of medicinal products at home
In October 2019, the Center received information about the death, in the intensive care unit of a central district hospital (hereinafter – CDH), of a female patient born in 1997 as a result of anaphylactic shock that developed after the use of two medicinal products.
A severe adverse reaction in the form of drug-induced anaphylactic shock occurred in a woman after she was given the beta-lactam antibiotic ceftriaxone intramuscularly, dissolved in 2 mL of 2% lidocaine solution, at home. The injection was administered by one of the woman's relatives, and timely, qualified emergency medical care was not provided. Only after 15 minutes had passed from the onset of the reaction did the emergency medical team begin resuscitation measures and urgently hospitalize the patient to the central district hospital.
Upon admission to the central district hospital (CDH), the patient's condition was assessed by the doctors as terminal. In the CDH intensive care unit, to which the woman was transferred, emergency medical care measures were applied. Despite the drug therapy and resuscitation measures carried out, 1 day 18 hours after the onset of the severe adverse reaction in the form of anaphylactic shock, biological death of the patient was recorded.
The pathoanatomical diagnosis confirmed the clinical diagnosis, namely, the cause of the woman's death was determined to be multiple organ failure and anaphylactic shock following the administration of medicinal products.
The main causes of anaphylactic shock are drug and insect (after insect stings) allergy. According to the literature, anaphylactic shock is recorded in 10% of patients with these forms of allergy, and in 10% of them it ends fatally.
Drug-induced anaphylactic shock is the most severe generalized manifestation of drug allergy, caused by a type I immunological reaction and the release of a large amount of cytokines, accompanied by marked disorders of the function of various organs and systems (cardiovascular, nervous, respiratory, etc.). With parenteral administration of drugs, drug-induced anaphylactic shock develops immediately; with oral administration, after 30-60 minutes.
We draw the attention of healthcare professionals to the fact that before using any medicinal product, it is necessary to properly read its instructions for medical use.
The medicinal products ceftriaxone and lidocaine are dispensed by prescription, as stated in the instructions for medical use.
Lidocaine may be administered only by healthcare professionals, and before its use a skin test for hypersensitivity to the medicinal product is mandatory, these warnings are also stated in the instructions for medical use.
In the section "Method of administration and doses" of the instructions for medical use of ceftriaxone, an important recommendation concerns the dosage of the antibiotic and the volume and concentration of the solvent, namely: for intramuscular injection, 1 g of ceftriaxone must be dissolved in 3,5 mL of 1% lidocaine solution.
The cautions given in the instructions for medical use of the medicinal products lidocaine and ceftriaxone were not taken into account when they were used at home.
To prevent similar cases in the future, it is important to follow these recommendations:
- The medicinal products ceftriaxone and lidocaine must be prescribed and dispensed by a physician’s prescription, as required by the package leaflet.
- Parenteral administration of the medicinal products ceftriaxone and lidocaine must be carried out only in a healthcare facility.
- A healthcare professional must read the information stated in the instructions for medical use before using any medicinal product.
- In the event of anaphylactic shock after the use of a medicinal product, the healthcare professional must promptly provide appropriate qualified medical care, which is one of the main conditions for a favorable prognosis for the patient.
Compliance with these recommendations will increase the likelihood of subsequent recovery and the avoidance of severe complications in patients with anaphylactic shock.
Thoughtless and overconfident performance of medical procedures at home, without the necessary safety measures and prevention of severe anaphylactic reactions, leads to irreversible consequences for the patient.
