Clinical Presentation & Protocol
Patient Usually Complains Of
Patient developed acute onset of symptoms within minutes of hemodialysis initiation, characterized by dyspnea, generalized urticaria, pruritus, and hypotension. No prior history of similar reactions. Current medication list reviewed for ACE inhibitors. Dialysis was immediately terminated without blood return.
Clinical Examination Findings
Patient appears in acute distress, diaphoretic, and tachypneic. Skin: diffuse erythematous rash and urticaria noted on trunk and extremities. Mucosal membranes: no angioedema of the tongue or lips. Alert and oriented, but anxious.
Treatment Protocol
Immediate cessation of dialysis. Discarded extracorporeal blood circuit. Administered IM Epinephrine (0.3-0.5 mg), IV fluids (normal saline bolus), IV antihistamines (diphenhydramine), and IV corticosteroids (methylprednisolone). Oxygen therapy initiated via nasal cannula. Continuous monitoring of vitals.