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Anaphylactoid reaction to pentastarch
1Department of Anaesthesia and Intensive Care, Palmerston North Hospital, New Zealand.
Summary
A patient experienced a probable anaphylactoid reaction to pentastarch, a hydroxyethyl starch (HES) colloid, presenting with severe hypotension and urticaria. Adrenaline was required for resuscitation, suggesting HES-induced anaphylaxis.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Pharmacology
Background:
- Hydroxyethyl starch (HES) solutions are commonly used as plasma volume expanders.
- Anaphylactoid reactions to HES, though rare, can be severe and life-threatening.
- Management of intracranial pressure and cerebral perfusion pressure is critical in head injury patients.
Observation:
- A young male with head injury developed profound hypotension and truncal urticaria during pentastarch infusion.
- The hypotension was refractory to noradrenaline but responded rapidly to adrenaline.
- Serum tryptase levels were not elevated in samples drawn early during the reaction.
Findings:
- The clinical presentation and response to treatment strongly suggest an anaphylactoid reaction to pentastarch (HES).
- The rapid onset of hypotension and urticaria points to a hypersensitivity response.
- Early serum tryptase measurements may not be reliable indicators of HES-induced anaphylaxis.
Implications:
- Clinicians should be vigilant for anaphylactoid reactions during HES administration, particularly in critically ill patients.
- Adrenaline is a crucial treatment for severe HES-induced anaphylaxis.
- Further investigation into the diagnostic utility of biomarkers for HES hypersensitivity is warranted.