Angioedema: Difference between revisions
(Created page with "==Background== *Angioedema is paroxysmal, nondemarcated swelling of dermal or submucosal layers of skin or mucosa **Swelling is asymmetric, nonpitting, and nonpruritic *4 etiolog...") |
No edit summary |
||
Line 39: | Line 39: | ||
==Disposition== | ==Disposition== | ||
*Consider discharge after obs | *Consider discharge after obs if there is no airway edema and pt improves | ||
==Source== | ==Source== |
Revision as of 15:01, 21 November 2011
Background
- Angioedema is paroxysmal, nondemarcated swelling of dermal or submucosal layers of skin or mucosa
- Swelling is asymmetric, nonpitting, and nonpruritic
- 4 etiologies:
- 1. Congenital or acquired loss of C1 esterase inhibitor
- 2. IgE–mediated type I allergic reaction
- 3. ACEI adverse reaction
- 4. Idiopathic
Hereditary Angioedema
Background
- Due to C1 esterase inhibitor deficiency
- Leads to unregulated activity of vasoactive mediators associated with complement pathway
- Autosomal dominant
Diagnosis
- Suspect in patients with history of recurrent peripheral angioedema and abdominal pain
- 75% experience onset of symptoms before age 15yr
- Decreased levels of C1 and C4 esterase inhibitors confirms diagnosis
Treatment
- Epinephrine IM can produce some improvement in early acute attacks
- C1 esterase inhibitor (if available)
- FFP
- Replaces the missing inhibitor protein
- Not recommended in life-threatening laryngeal edema (some pts may become more edematous)
- Instead, pt should undergo fiberoptic intubation w/ preparation for surgical airway
ACE Inhibitor-induced Angioedema
Background
- Incidence is highest within the first month; however, may occur at anytime
- Incidence is 0.1-2.2% (more common in blacks)
Treatment
- Epinephrine 0.3mg IM q15-20min prn
- Diphenhydramine 50mg IV OR cetirizine 10mg PO
- Methylprednisolone 125mg IV
- Awake fiberoptic intubation
Disposition
- Consider discharge after obs if there is no airway edema and pt improves
Source
Tintinalli