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RANITIDINE ANAPHYLAXIS
- HASHER P KADAVIL (14 November 2005)
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HASHER P KADAVIL, Senior House Officer,Anaesthetics QUEENS HOSPITAL,BURTON,DE13 0RB
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Editor- I read with interest the article by M.Kroigaard and colleagues about Allergic reactions in anaesthesia. It’s very heartening to know that allergic reactions are very uncommon in anaesthesia(1:10000 to 1:20000)..The study is very extensive and interesting. A large number of drugs are implicated in causing or suspected to have causing allergic reaction. I would like to report a case of severe allergic reaction to a drug not mentioned in the above article.The drug is ranitidine.Ranitidine is prescribed to all patients in many ITU’s as standard protocol who do not have a previous H2 blocker or proton pump inhibitor prescribed. An 86 year old lady to the hospital with suspected pancreatitis.She was later admitted to the H D U for respiratory support as she had worsening oxygenation in the ward. She was already on 2 antibiotics (cefuroxime, metronidazole) and enoxaparin when she arrived in the H D U.She was prescribed I V ranitidine (Zantac-Glaxo Smith Kline) 50 mg thrice daily. The first dose of ranitidine was administered at 8 am.5 minutes later she developed bronchospasm and bradycardia which led to PEA(Pulse less Electrical Activity) for 2 minutes. She was resuscitated with CPR and adrenaline. A chest x ray revealed pleural effusion on the right side. A chest tube was inserted which drained 600 mls of blood stained fluid. Ranitidine allergy was never reported in the ITU before. For that reason the drug was never suspected to have caused the reaction even though the event occurred just after administering ranitidine. At 4 in the evening the next dose of ranitidine was administered (50 mg IV).Immediately the patient manifested severe bronchospasm and hypotension which was successfully treated with 0.5mg adrenaline IV and hydrocortisone. She successfully recovered from the episode and was discharged to the ward 6 days later. This goes to show that almost all drugs have the potential to cause allergic reactions. The authors have rightly said that allergic reactions are uncommon in anaesthesia but when they occur they are serious and life threatening. Conflict of Interest:None declared |
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