From the Research
Reynolds's Pentad is a medical emergency that requires immediate intervention with broad-spectrum antibiotics, such as piperacillin-tazobactam 4.5g IV every 6 hours, and urgent biliary decompression via endoscopic retrograde cholangiopancreatography (ERCP). The five components of Reynolds's Pentad are fever, right upper quadrant abdominal pain, jaundice, hypotension, and altered mental status, which indicate a severe form of ascending cholangitis, specifically acute suppurative cholangitis 1. This condition is an extension of Charcot's triad (fever, jaundice, and right upper quadrant pain) with the addition of hypotension and altered mental status, indicating a more severe infection with systemic involvement.
Clinical Presentation and Diagnosis
The presence of all five signs of Reynolds's Pentad is relatively rare but carries a high mortality rate without prompt treatment, as bacteria and their toxins from the obstructed biliary system enter the bloodstream, leading to septic shock and multi-organ dysfunction 2. The diagnosis of Reynolds's Pentad is based on clinical and biochemical parameters, including symptoms, vital signs, and laboratory data, such as liver function tests and blood cultures 3.
Treatment and Management
Treatment involves fluid resuscitation, broad-spectrum antibiotics, and urgent biliary decompression, typically via ERCP 4. Patients should be closely monitored in an intensive care setting with frequent vital sign checks and laboratory assessments. The use of piperacillin-tazobactam has been shown to be effective in the treatment of severe infections, including those caused by bacteria with plasmid-mediated beta-lactamases 5. However, a recent study suggests that dose reduction of piperacillin-tazobactam in septic shock patients may be associated with worsened clinical outcomes, highlighting the importance of using the recommended dose 4.
Key Considerations
- The presence of Reynolds's Pentad indicates a severe infection with systemic involvement and requires immediate intervention.
- Broad-spectrum antibiotics, such as piperacillin-tazobactam, should be used at the recommended dose to ensure effective treatment.
- Urgent biliary decompression via ERCP is essential to eliminate the underlying obstruction and prevent further complications.
- Patients should be closely monitored in an intensive care setting to ensure prompt recognition and management of any complications that may arise.