ABSTRACT
Intrathecal opioid pain pumps (IPP) are sometimes prescribed for treatment of chronic nonmalignant pain. Severe urinary retention is not a commonly reported side effect of the IPP. In this case, an elderly female with multiple comorbidities presented with acute onset of severe urinary retention immediately following morphine IPP placement for chronic peripheral neuropathy. Multiple management strategies for urinary retention were employed. However, the urinary retention only fully resolved once the IPP was disabled. This case highlights the need to closely monitor chronic pain patients with complex medical histories who may be uniquely predisposed to opioid-mediated severe urinary retention.
ABSTRACT
Anaphylaxis is an acute, potential life-threatening systemic allergic reaction that may have a wide range of clinical manifestations. Severe anaphylaxis and/or the need for repeated doses of epinephrine to treat anaphylaxis are risk factors for biphasic anaphylaxis. Antihistamines and/or glucocorticoids are not reliable interventions to prevent biphasic anaphylaxis, although evidence supports a role for antihistamine and/or glucocorticoid premedication in specific chemotherapy protocols and rush aeroallergen immunotherapy. Evidence is lacking to support the role of antihistamines and/or glucocorticoid routine premedication in patients receiving low- or iso-osmolar contrast material to prevent recurrent radiocontrast media anaphylaxis. Epinephrine is the first-line pharmacotherapy for uniphasic and/or biphasic anaphylaxis. After diagnosis and treatment of anaphylaxis, all patients should be kept under observation until symptoms have fully resolved. All patients with anaphylaxis should receive education on anaphylaxis and risk of recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and be educated about thresholds for further care.
