From the Guidelines
Medication-related shock is primarily anaphylactic shock, which occurs when a person has a severe allergic reaction to a medication, as highlighted in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. This type of shock is a life-threatening condition that requires immediate medical attention. According to the guidelines, anaphylaxis is a multisystem disease that can cause vasodilatory shock, which is a leading cause of morbidity and mortality in patients with medication-related shock 1.
Key Characteristics of Anaphylactic Shock
- Occurs in response to an adverse reaction to pharmacological agents
- Can cause respiratory tract involvement, such as edema and bronchospasm
- Can cause circulatory system involvement, such as vasodilatory shock
- Requires immediate treatment with epinephrine, which is the cornerstone of treatment for anaphylaxis 1
Treatment and Management
- Immediate administration of epinephrine (typically 0.3-0.5mg intramuscularly for adults)
- Antihistamines and corticosteroids may be used as adjunctive therapy
- Supportive care, including IV fluids to maintain blood pressure, is crucial in managing anaphylactic shock
- Patients with a history of medication-induced anaphylaxis should take precautions, such as wearing medical alert identification and carrying emergency epinephrine auto-injectors at all times.
From the FDA Drug Label
The following adverse reactions have been associated with use of epinephrine. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to estimate their frequency reliably or to establish a causal relationship to drug exposure cardia, ventricular arrhythmias (including fatal ventricular fibrillation), myocardial ischemia, myocardial infarction, limb ischemia, pulmonary edema, hypertension
The type of shock related to medication, specifically an adverse reaction to pharmacological agents, is anaphylactic shock or cardiogenic shock due to myocardial ischemia or arrhythmias.
- Anaphylactic shock is not explicitly mentioned but can be inferred from the allergic reactions associated with sulfite.
- Cardiogenic shock can occur due to myocardial ischemia or arrhythmias caused by epinephrine. 2 2
From the Research
Types of Shock
- There are four major categories of shock: hypovolemic, distributive, cardiogenic, and obstructive shock 3
- These categories are mainly related to one of four organ systems: blood and fluids compartment, vascular system, heart, and circulation
Medication-Related Shock
- Pharmacologically induced shock can be refractory to standard resuscitation 4
- Methylene blue may be a potential treatment for refractory shock, particularly in cases of calcium channel blocker overdose 4
- Vasopressors and inotropes are vasoactive medications used to increase systemic vascular resistance and cardiac contractility in patients with shock 5, 6
Characteristics of Medication-Related Shock
- Medication-related shock can be caused by an adverse reaction to pharmacological agents, such as calcium channel blockers, beta blockers, and other medications 4
- The treatment of medication-related shock depends on the underlying cause and may involve the use of vasopressors, inotropes, and other medications 5, 6