[Anaphylactic shock and low osmolarity contrast medium]. / Choc anaphylactique et produit de contraste de faible osmolarité.

BACKGROUND: Low osmolality contrast media are generally better tolerated than those with high osmolality. This report describes a case of severe collapse after injecting a low osmolality contrast medium. CASE REPORT: A 15 month-old girl with aortic arch abnormalities was admitted for investigation under general anesthesia. She had a history of allergy but had not previously been exposed to contrast medium. She was given ioxaglate (2 mg/kg) into an artery. The infusion immediately resulted in generalized erythema, tachycardia, hypotensive collapse and ECG abnormalities. The patient was immediately given adrenaline, vasopressive drugs, corticosteroids and plasma protein fraction, which led to a rapid recovery. The ductus arteriosus was ligated a few days later without complications despite the application of iodine to the skin and the use of anesthetic drugs. CONCLUSION: An unpredictable adverse reaction to low osmolality contrast medium can occur. Risk factors must be identified and immediate arrangements made for resuscitation.

[Severe poisoning risk linked to intravenous administration of quinine]. / Les risques d'intoxication grave liés à l'administration intraveineuse de quinine.

BACKGROUND: High concentrations of quinine, the drug of choice for severe malaria, are toxic to the cardiovascular system, producing hypotension and abnormal myocardial conduction. CASE REPORTS: Five children, aged 14 months to 13 years, were admitted because of fever that appeared a few days after their return from an area in which malaria was endemic. Examination of a thick blood film showed Plasmodium falciparum. They were given quinine intravenously. Four children developed a seizure that recurred in three of them; the fifth child suffered from headache, buzzing in the ears and vision anomalies. Four children rapidly developed hypotension followed by cardiac arrest. All children had abnormal ECG. Retrospective study of the instructions given for quinine administration showed that they were inexplicit and were responsible for incorrect dilution of the drug. Four of the five children recovered completely. The fifth child developed ventricular tachycardia followed by bradycardia that did not respond to resuscitation. CONCLUSION: Major errors can be made in prescribing intravenous quinine. This type of treatment must be carefully monitored and is only indicated in severe forms of malaria, which our patients were not suffering from.

[Atrioventricular block complicating the use of diphemanil (Prantal) in 2 premature newborn infants]. / Bloc auriculo-ventriculaire compliquant l'utilisation du diphémanil (Prantal) chez deux nouveau-nés prématurés.

BACKGROUND: Diphemanil can be useful in some neonates presenting with bradycardia due to vagal hyperreflectivity. Paradoxically, this drug may induce atrio-ventricular (AV) block in premature babies. CASE REPORTS: Case no 1. A premature neonate suffering from acute respiratory distress from birth required respiratory support, antibiotics and caffeine. Despite this treatment, he underwent many episodes of apnea, and bradycardia that appeared on day 4 and did not respond to IV doxapram (1 mg/kg/h). He was given diphemanil on day 9 (10 mg/kg/d) and permanent bradycardia with complete AV block and a normal QT interval appeared 2 days later. Cessation of diphemanil and administration of IV isoprenaline led to a normal sinusal rhythm, but there were bladder, intestinal and ocular signs of atropinic intoxication. A complete definitive recovery occurred 5 days after cessation of diphemanil. Case no 2. A premature neonate developed episodes of apnea 2 days after birth. These episodes persisted and were complicated by bradycardia on day 4 despite administration of caffeine. Vagal stimulation on day 7 was positive and the infant was then given diphemanil (10 mg/kg/d). Permanent bradycardia occurred 2 days later, with partial AV block and a normal QT interval. The child recovered a normal sinusal rhythm 2 days after cessation of diphemanil. CONCLUSIONS: Anticholinergic therapy may cause permanent bradycardia due to AV block in premature infants. This therapy should not be given to premature infants without a prior ECG. Doses lower than those used in infants are recommended.