Anaphylactic Shock

Dessy Resandini
Dianita Dwi Puji Rahayu
Thesar Waldi
Yessy Adhi Utami
Shock
Acute circulatory failure, leading to decreased organ
perfusion, with inadequate delivery of oxygenated blood
to tissue and result in end-organ dysfunction

• Types of shock:
• Hypovolemic
• Cardiogenic
• Obstructive
• Distributive
Distributive Shock
is characterized by profound systemic vasodilatation and is
commonly associated with relative intravascular volume
depletion

Causes:
• Sepsis
• Anaphylaxis
Anaphylaxis
Is a systemic, type I hypersensitivity reaction that results in
mucocutaneous, cardiovascular and respiratory
manifestation – can often be life threatening.

It is also a serious allergic reaction with acute onset, that may happen
to people of all ages

Anaphylactoid reactions are identical to anaphylaxis except for the

mediation of IgE – however, due to the similarity, both are termed
anaphylaxis.
Prevalence
• Lifetime prevalence: 1.6-5%
• Food: most common cause of anaphylaxis – accounting for 30%
• Peanuts
• Fish
• Cow’s Milk
• Amongst medications, antibiotics – primarily penicillin, cause most
episodes of anaphylaxis
Pathophysiology
• Result from systemic release of mediators from mast cells and
basophils

• Mediators:
• Histamine
• Tryptase
• Cytokines
• prostaglandines
 Sign and Symptoms
Mucocutaneous Respiratory Cardiovascular Gastrointestinal

Urticaria Dyspnea Hypotension Nausea

Angioedema Throat tightness Tachycardia Vomiting

Pruritus Wheezing Syncope Abd cramps

Flushing Stridor Diarrhea

Kriteria
Diagnosis
Kriteria
Diagnosis
Grading of anaphylactic reactions according to severity of clinical symptoms
Symptoms
Grade Dermal Abdominal Respiratory Cardiovascular
I Pruritus
Flush
Urticaria
Angiodema
II Pruritus Nausea Rhinorrhoea Tachycardia (> 20 bpm)
Flush Cramping Hoarseness Blood pressure change (>
Urticaria Dyspnoea 20 mmHg systolic)
Angiodema (not Arrhytmia
mandatory)
III Pruritus Vomiting Laryngeal oedema Shock
Flush Defecation Bronchospasm
Urticaria Diarroea Cyanosis
Angiodema (not
mandatory)
IV Pruritus Vomiting Respiratory arrest Cardiac arrest
Flush Defecation
Urticaria Diarrhoea
Angiodema (not
mandatory)
Bpm = beats perminute
Ring J, Brockow K & Behrendt. History and classification of anaphylaxis. In Anaphylaxis. Novartis Foundation 2004:12
Differential Diagnosis
Disease / Condition Differentiating Sign or Symptoms

Septic Shock Absence of previous allergic reaction

Slower onset
Locailzed Infection

Hypovolemic Shock Water / fluid loss occurs via profuse blood loss /
vomiting / diarrhea

Vasovagal Reaction Absent of allergic history

Presence of bradycardia
Management