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Avoid subcutaneous or intramuscular adrenaline
EDITOR,--Malcolm Fisher states that intravenous adrenaline should be used only in severe cases of anaphylaxis as it may cause arrhythmias1 and cites a publication by Waldhausen et al.2 In this paper the doses given intravenously were up to 20 times the initial dose recommended by the Association of Anaesthetists of Great Britain and Ireland.3 Previous authors have also expressed misgivings about using intravenous adrenaline on the basis of anecdotal reports in which the speed of administration was not stated and other causes of arrhythmias were not excluded.4 Like any other drug, adrenaline may be dangerous if given too fast or in an excessive dose, but it is illogical to restrict its use because of concerns over complications caused by inappropriate administration.
Ideally, intravenous adrenaline should be the first line treatment for all patients with anaphylaxis treated by medically trained staff. It is safe and effective if given in a controlled
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- Fortnightly Review: Treatment of acute anaphylaxis
- Malcolm Fisher
BMJ 1995 311: 731-733.[Abstract] [Full Text]
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