RESUMO
Anaphylaxis is a life-threatening response to various types of allergens. Early recognition and management are crucial for reducing mortality. This case report highlights a 31-year-old male with a background of hypertension who presented to the emergency department with nausea, vomiting, right flank pain, headache, and elevated blood pressure (BP) of 212/134 mmHg. The patient was started on stat captopril 12.5 mg tablet and stat amlodipine 5 mg tablet for his high BP and stat diclofenac 75 mg (1 mg/kg) intramuscular (IM) for his flank pain. Two minutes later the patient started developing swelling of his mucosal membranes with no urticaria or rashes and his BP suddenly dropped and was unrecordable. First-line management was immediately initiated including the administration of two standard adult doses of IM epinephrine of 500 mcg each with a 5-minute interval. The BP remained undetectable; accordingly, a third IM epinephrine dose of 500 mcg was administered along with an intravenous (IV) epinephrine drip initiated at a rate of 4 mcg/min. The BP became 60/40 mmHg but kept dropping, thus an IV epinephrine bolus of 300 mcg (4 mcg/kg) was given along with the ongoing IV epinephrine drip. BP increased to 126/75 mmHg. While on the IV epinephrine drip the BP dropped again to 88/59 mmHg, a second IV epinephrine bolus of 200 mcg (2.6 mcg/kg) was given and the BP became 140/90 mmHg and recovery was achieved. Emergency cases require immediate recognition and intervention. Currently, IM epinephrine is the primary treatment for anaphylaxis. We hope our case report contributes to the database on severe refractory anaphylaxis by discussing a successful case where IV bolus epinephrine was used to prevent imminent cardiovascular collapse. Highlighting the need for appropriate escalation of management given the availability of physicians with expertise.
RESUMO
In the past three decades, macroinvertebrate traits have been explored and employed in the biomonitoring of riverine systems globally, but much attention has not been given to the trait-based approach (TBA) in Nigeria. Therefore, in this study, the distribution patterns of macroinvertebrate traits in selected stations exposed to varying degrees of perturbation in River Hadejia, north-western Nigeria, were explored to assess the ecological health of the river. Three stations were selected, representing an increasing gradient of pollution: station 1 > station 2 and station 3, and were used to search for potential indicator traits. Four traits, including body size, respiratory, mobility, and body shape, were selected and classified into 12 trait attributes. The RLQ analysis revealed macroinvertebrates possessing medium and large body sizes, climbing and crawling, tegumental, gills, and aerial: lungs respiratory traits, and streamlined body shape were associated with station 1. Conversely, macroinvertebrates possessing very small and small body sizes, aerial: spiracle and aerial/vegetation, sprawling, swimming, and skating, flattened, spherical, cylindrical, and rhomboidal were mainly associated with stations 2 and 3. In searching for potential indicator macroinvertebrate traits aside from the RLQ analysis conducted, a fourth-corner analysis was further performed, which showed traits including medium and large body sizes, tegumental, and aerial: lung respiratory traits to be sensitive to pollution. Equally, aerial/vegetation, flattened body shape, and very small body size were found to be tolerant of pollution. A more robust trait-based biomonitoring study using more trait classes such as feeding mechanism, food preferences, voltinism, and attachment mechanism is recommended for future study in this region. The study would be helpful in biomonitoring of ecosystem health and enhance the sustainability prowess of the TBA in the studied region.
