Clinical management of Anaphylactic Shock in Uganda

General Measures (All LOC)

Determine and remove the cause. Secure the airways. Restore BP by laying the patient flat and raising feet. Keep patient warm.

Volume Resuscitation (HC2)

Sodium chloride 0.9% infusion 20 ml/kg by IV infusion over 60 minutes. Start rapidly then adjust rate according to BP. Administer oxygen.

Primary Pharmacotherapy (HC3/HC4)

Adrenaline (epinephrine) 1 in 1,000 (1 mg/ml) — 0.5 mg (0.5 ml) IM immediately into the anterolateral thigh. Repeat every 5–10 minutes according to BP, pulse rate, and respiratory function until better.

Severely Affected Patients

Hydrocortisone 200 mg IM or slow IV stat. Repeat every 2–6 hours prn depending on patient progress.

If Urticaria / Itching

Give antihistamine as adjunctive treatment: Chlorpheniramine 4 mg every 6 hours. OR Cetirizine 5 mg once daily. OR Promethazine 25–50 mg by deep IM or very slow IV. Repeat dose every 8 hours for 24–48 hours to prevent relapse.

Monitoring

Monitor the patient for several hours — reaction may recur after several hours. If drug reaction, complete adverse drug reaction reporting form.

Volume Resuscitation

Sodium chloride 0.9% infusion 20 ml/kg IV over 60 minutes. Start rapidly then adjust according to BP.

Adrenaline — Child < 6 years

Adrenaline (epinephrine) 1 in 1,000: 150 micrograms (0.15 ml) IM into anterolateral thigh. Repeat every 5–10 minutes according to BP, pulse, and respiratory function until better.

Adrenaline — Child 6–12 years

Adrenaline (epinephrine) 1 in 1,000: 300 micrograms (0.3 ml) IM into anterolateral thigh. Repeat every 5–10 minutes as needed.

Hydrocortisone — Child < 1 year

Hydrocortisone 25 mg IM or slow IV stat. Repeat every 2–6 hours as needed.

Hydrocortisone — Child 1–5 years

Hydrocortisone 50 mg IM or slow IV stat.

Hydrocortisone — Child 6–12 years

Hydrocortisone 100 mg IM or slow IV stat.

Antihistamine — Child 1–2 years

Chlorpheniramine 1 mg every 12 hours. OR Cetirizine 2.5 mg once daily.

Antihistamine — Child 2–5 years

Chlorpheniramine 1 mg every 6 hours.

Antihistamine — Child 5–12 years

Chlorpheniramine 2 mg every 6 hours. OR Cetirizine 5 mg daily (≥6 years). OR Promethazine 6.25–12.5 mg by deep IM. Repeat every 8 hours for 24–48 hours.