Page 1800 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 128: Anaphylactic and Anaphylactoid Reactions 1269

should be directed at the underlying process. The use of bicarbonate
to correct the pH is controversial. When bicarbonate is given, serum • Murali S, Baldisseri MR. Peripartum cardiomyopathy. Crit Care
Med. October 2005;33(suppl 10):S340-S346.
carbon dioxide levels rise, and carbon dioxide diffuses rapidly across
the placenta. Maternal bicarbonate equilibrates more slowly across the • Murphy VE, Gibson PG. Asthma in pregnancy. Clin Chest Med.
placenta. Thus, infused bicarbonate may contribute to systemic acidosis March 2011;32(1):93-110, ix.
in the fetus. • Neligan PJ, Laffey JG. Clinical review: special populations—
■ NUTRITION critical illness and pregnancy. Crit Care. 2011;15(4):227.

During states of inadequate nutrition, the mother is favored over the • Rahangdale L. Infectious complications of pregnancy termination.
Clin Obstet Gynecol. June 2009;52(2):198-204.
fetus. Aggressive nutritional support should be instituted early in the • Rojas-Suarez J, Paternina-Caicedo AJ, Miranda J, Mendoza R,
course of critical illness. The gut should be used if possible. Caloric Dueñas-Castel C, Bourjeily G. Comparison of severity-of-Illness
requirements during pregnancy are approximately 40 kcal/kg per day. scores in critically ill obstetric patients: a 6-year retrospective
Sepsis, trauma, burns, and recent surgery are likely to increase this cohort. Crit Care Med. 2014;42:1047-1054.
requirement. Unless severe liver disease is present, 1.5 g/kg per day of
protein should be given. Approximately 20% of calories should be pro- • Siston AM, Rasmussen SA, Honein MA, et al. Pandemic 2009
vided as lipids. Calcium, phosphate, and magnesium levels should be influenza A(H1N1) virus illness among pregnant women in the
monitored, and additionally supplemented as necessary. Patients who do United States. JAMA. April 21, 2010;303(15):1517-1525.
not tolerate enteral feeding will require total parenteral nutrition (TPN). • Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R.
Extended TPN has been used in pregnant patients for disorders such as Pre-eclampsia. Lancet. August 21, 2010;376(9741):631-644.
inflammatory bowel disease, esophageal stricture, and malignancy. Its
171
use in acute nutritional insufficiency associated with critical illness is
less well described.
REFERENCES
Complete references available online at www.mhprofessional.com/hall
KEY REFERENCE
• Ahonen J, Stefanovic V, Lassila R. Management of post-par-
tum haemorrhage. Acta Anaesthesiol Scand. November CHAPTER Anaphylactic and
2010;54(10):1164-1178. Anaphylactoid Reactions
• Brent R. The pulmonologist’s role in caring for pregnant women 128
with regard to the reproductive risks of diagnostic radiological Debendra Pattanaik
studies or radiation therapy. Clin Chest Med. March 2011;32(1): Jose C. Yataco
33-42, vii-viii. Phil Lieberman
• Brito V, Niederman MS. Pneumonia complicating pregnancy. Clin
Chest Med. March 2011;32(1):121-132, ix.
• Chames MC, Pearlman MD. Trauma during pregnancy: out- KEY POINTS
comes and clinical management. Clin Obstet Gynecol. June 2008; • Anaphylaxis is an acute life-threatening systemic reaction that
51(2):398-408. results from sudden systemic release of mediators from mast cells
• Conde-Agudelo A, Romero R. Amniotic fluid embolism: an evi- and basophils.
dence-based review. Am J Obstet Gynecol. November 2009;201(5): • Degranulation of mast cell and basophils are commonly mediated
441-453. by IgE antibody. Other nonimmunologic mechanisms including
• Duley L, Gulmezoglu AM, Henderson-Smart DJ, Chou D. direct activation of these cells have been described.
Magnesium sulphate and other anticonvulsants for women with • The incidence of anaphylaxis appears to be rising, especially
pre-eclampsia. Cochrane Database Syst Rev. 2010(11):CD000025. among young people.
• Honiden S, Abdel-Razeq SS, Siegel MD. The management of the • Foods followed by medications (eg, antibiotics and NSAIDs) are
critically ill obstetric patient. J Intensive Care Med. 2013; 28:93-106. the most common cause of anaphylaxis in the outpatient setting.
• Jeejeebhoy FM, Zelop CM, Windrim R, Carvalho JC, Dorian • Medications, for example, antibiotics, muscle relaxants, blood
P,Morrison LJ. Management of cardiac arrest in pregnancy: a products, and radiocontrast media, are common causes of
systematic review. Resuscitation. July 2011;82(7):801-809. anaphylaxis in the hospital.
• Kealey A. Coronary artery disease and myocardial infarction • Onset of symptoms of anaphylaxis is usually immediate but can be
in pregnancy: a review of epidemiology, diagnosis, and medical delayed by 2 to 10 hours.
and surgical management. Can J Cardiol. June-July 2010;26(6):
185-189. • Cutaneous symptoms are common but hemodynamic collapse and
• Lane CR, Trow TK. Pregnancy and pulmonary hypertension. Clin shock can occur in the absence of skin manifestations.
Chest Med. March 2011;32(1):165-174, x. • The hemodynamic symptoms of anaphylaxis are secondary to the
• Leung AN, Bull TM, Jaeschke R, et al. An official American Thoracic widespread vasodilation and profound intravascular fluid loss.
Society/Society of Thoracic Radiology clinical practice guideline: • Careful history and physical examination are most important in
evaluation of suspected pulmonary embolism in pregnancy. Am the diagnosis of anaphylaxis. Measurement of serum tryptase and
J Respir Crit Care Med. November 15, 2011;184(10):1200-1208. histamine can be helpful.
• Montagnana M, Franchi M, Danese E, Gotsch F, Guidi GC. • Prompt recognition, administration of epinephrine, and
Disseminated intravascular coagulation in obstetric and gyneco- intravascular volume replacement are key factors in the successful
logic disorders. Semin Thromb Hemost. June 2010;36(4):404-418. outcome of this potentially fatal event.

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