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Initial Treatment of Anaphylactic Reactions [1]

Initial treatment of anaphylactic reaction (hives, flushing, wheezing, shortness of breath, chest pain, tachycardia  hypotension, etc) :

Stop infusion or medication and give:

  • Epinephrine 0.3 mg (0.3 ml of 1:1000)subcutaneous/IM . Repeat x 1 after 15 minutes for persistent symptoms.

  • Diphenhydramine 50 mg IV x 1 dose

  • Ranitidine 1 mg per kg IV

  • Treat hypotension with large volume of isotonic crystalloid IV fluid (bolus).

  • Hydrocortisone, 5 mg per kg, or approximately 250 mg IV

REFERENCES:
1. Tang AW. A Practical Guide to Anaphylaxis. Am Fam Physician. 2003 1;68(7):1325-32. Review. Erratum in: Am Fam Physician. 2004 Mar 1;69(5):1049. PMID: 14567487

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