Glucagon Reversal of Hypotension in a Case of Anaphylactoid Shock

Brief Reports1 July 1986Glucagon Reversal of Hypotension in a Case of Anaphylactoid ShockGARY P. ZALOGA, M.D., WILLIAM DELACEY, M.D., ERIC HOLMBOE, M.D., BART CHERNOW, M.D.GARY P. ZALOGA, M.D., WILLIAM DELACEY, M.D., ERIC HOLMBOE, M.D., BART CHERNOW, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-105-1-65 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptGeneralized anaphylactoid reactions are acute life-threatening emergencies requiring prompt and aggressive therapy, usually with beta-adrenergic compounds such as epinephrine (1). However, beta-adrenergic agonists may be ineffective in reversing hypotension in patients receiving beta-adrenergic blocking agents (2). We report the case of a patient treated with these agents who developed hypotension after radiocontrast dye injection. Hypotension was effectively reversed after the intravenous administration of glucagon.A 75-year-old white man was transferred to the intensive care unit for treatment of a generalized anaphylactoid reaction. The patient had been scheduled for computed tomography of his head for the evaluation of new-onset vertigo. Within...References1. BARACH E, NOWAK R, LEE T, and TOMLANOVICH M. Epinephrine for treatment of anaphylactic shock. JAMA. 1984;251:2118-22. CrossrefMedlineGoogle Scholar2. WEINSTEIN R. Recognition and management of poisoning with beta-adrenergic blocking agents. Ann Emerg Med. 1984; 13:1123-31. CrossrefMedlineGoogle Scholar3. GREENBERGER P. Contrast media reactions. J Allergy Clin Immunol. 1984;74:600-5. CrossrefMedlineGoogle Scholar4. WASSERMAN S. Anaphylaxis. In: MIDDLETON E, REED CE, ELLIS EF, eds. Allergy: Principles and Practice. St. Louis: C.V. Mosby Company; 1983; 689-99. Google Scholar5. HALL-BOYER K, ZALOGA G, and CHERNOW B. Glucagon: hormone or therapeutic agent? Crit Care Med. 1984;12:584-9. CrossrefMedlineGoogle Scholar6. FARAH A. Glucagon and the circulation. Pharmacol Rev. 1983;35:181-217. MedlineGoogle Scholar7. GLICK G, PARMLEY W, WECHSLER A, and SONNENBLICK E. Glucagon: its enhancement of cardiac performance in the cat and dog and persistence of its inotropic action in spite of beta-receptor blockade with propranolol. Circ Res. 1968;22:789-99. CrossrefMedlineGoogle Scholar8. ILLINGWORTH R. Glucagon for beta-blocker poisoning. Practitioner. 1979;223:683-5. MedlineGoogle Scholar9. FROMMER P, ROBINSON B, and BRAUNWALD E. Studies on digitalis: XII. The effects of paired electrical stimulation on digitalis-induced arrhythmias. J Pharmacol Exp Ther. 1966;151:1-6. MedlineGoogle Scholar10. LUCCHESI B. Cardiac actions of glucagon. Circ Res. 1968;22:777-87. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: GARY P. ZALOGA, M.D.; WILLIAM DELACEY, M.D.; ERIC HOLMBOE, M.D.; BART CHERNOW, M.D.Affiliations: Naval Hospital and Uniformed Services University of the Health Sciences Bethesda, Maryland PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIncreased Excretion of Mast Cell Mediator Metabolites During Mast Cell Activation SyndromeAsthma and AllergyAnaphylaxisSuccessful treatment of severe adrenaline-resistant anaphylactic shock with glucagon in a patient taking a beta-blocker: a case reportGlucagon reversal of shock in a case of refractory anaphylaxisManagement of Anaphylaxis Refractory to Standard First Line TherapyAnaphylaxis for InternistsRefractory Anaphylaxis: Data From the European Anaphylaxis RegistryPerioperative anaphylaxis: pathophysiology, clinical presentation and managementAnaphylactic Shock in PregnancyAnaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6)Risk factors and treatment of refractory anaphylaxis - a review of case reportsAre ACE Inhibitors and Beta-blockers Dangerous in Patients at Risk for Anaphylaxis?AnaphylaxisAnaphylaxis—a practice parameter update 2015Addition of glucagon to adrenaline improves hemodynamics in a porcine model of prolonged ventricular fibrillationAnaphylaxisMethylene blue for the treatment of refractory anaphylaxis without hypotensionThe Risk and Management of Anaphylaxis in the Setting of ImmunotherapyAnaphylaxis: mechanisms and managementAnaphylactic Shock in PregnancyMécanismes immunologiques de l'allergie peranesthésiqueEffects of β-adrenoceptor antagonists on anaphylactic hypotension in conscious ratsAllergen immunotherapy: A practice parameter third updateThe diagnosis and management of anaphylaxis practice parameter: 2010 UpdateThe Use of Vasopressors and Inotropes in the Emergency Medical Treatment of ShockManagement of Beta-Adrenergic Blocker PoisoningDo β-blockers really enhance the risk of anaphylaxis during immunotherapy?Anaphylaxis and Anaphylactic ShockImaging Contrast AgentsManagement of the Patient with AnaphylaxisRole of nitric oxide production in anaphylaxis and its relevance for the treatment of anaphylactic hypotension with methylene blueHymenoptera sting-induced Kounis syndrome: Effects of aspirin and β-blocker administrationThe management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunologyAnaphylaxisNavigating the Updated Anaphylaxis ParametersThe Pathophysiology of Shock in AnaphylaxisSeasonal and Acute Allergic ReactionsAntibacterial and Antifungal AgentsAnaphylaxie und anaphylaktischer Schock2. 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