Coronary Vasospasm and Acute Cardiogenic Shock Following Intravenous Epinephrine Administration in Anaphylaxis: A...

Anaphylaxis is a serious systemic hypersensitivity reaction that, without swift medical intervention, can be life-threatening. First-line treatment in adults is with 0.01 mg/kg (maximum 0.5 mg) of intramuscular epinephrine. However, inadvertent administration of epinephrine intravenously can lead to serious cardiovascular ramifications. This case describes a military recruit in basic training who developed multivessel coronary vasospasm and stress cardiomyo-pathy in response to an inappropriately administered dose of 1 mg of intravenous (IV) epinephrine for anaphylaxis after consuming shrimp. The majority of IV epinephrine-induced vasospasm has been documented in older individuals and those with underlying coronary artery disease. This case demonstrates that cardiovascular complications related to high doses of epinephrine can affect young, otherwise healthy individuals as well. Moreover, this case highlights the importance of appropriate dose administration and sufficient training of military medical personnel in the management of medical emergencies both stateside and in deployed settings.