This case involves a male patient who had an anaphylactic reaction to cashew nuts. Initial management included Benadryl and steroids. The patient’s condition deteriorated and the decision to administer epinephrine was made. The nurse started an IV and the physician gave orders for a specific dosage of epinephrine. There was some uncertainty as to the exact dosage necessary. As a result, the patient was given 1 mg. The infant immediately became tachycardic in the 180s.
Question(s) For Expert Witness
What is the proper treatment for anaphylaxis in an infant?
Expert Witness Response
Anaphylaxis is a potentially fatal disorder, especially in an infant as they are more sensitive to medication dosages and can often suffer from drug toxicity more readily. The above physician misunderstood the dosing schedule of epinephrine. For an infant, the appropriate dosing regime is 0.01 mg per kg. Therefore, by giving 1 mg of epinephrine, the patient received nearly three times the recommended dose. Some of the side effects of epinephrine include tachycardia, which is portrayed in this case. Situations like these can be avoided by double checking the dosage with the nurse and reading aloud the medication before administering it to the patient.
About the author
Dr. Faiza Jibril
Dr. Faiza Jibril has extensive clinical experience ranging from primary care in the United Kingdom, to pediatrics and child abuse prevention at Mount Sinai Hospital, to obstetrics in Cape Town, South Africa. Her post-graduate education centered on clinical research and medical ethics. Dr. Jibril is currently Head of Sales in the US and Canada for Chambers and Partners - a world leading legal ranking and insights intelligence company.
