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Do I understand that the patient noticed lip swelling at home, went to the pharmacy where he received Phenergan, and that after he took the medication, his lip swelling worsened? You then treated him for presumed anaphylaxis when he came to the clinic for routine lab work? The epi you gave him did not bring about improvement of his swollen lip?
He did not develop other signs or symptoms of respiratory distress such as tongue or facial swelling or difficulty breathing. You don't mention vital signs or other aspects of physical assessment. Did he c/o dizziness, weakness, have itching or a rash? Was he tachypneic, hypotensive?
Is it possible that his swollen lip may not have been caused by an allergic reaction?
My thoughts would be...what about adding a corticosteroid or at least an H2 blocker for this angioedema (no signs of anaphylaxis in your post) if no improvement after the Epi and there were concerns with giving another H1 blocker on top of the Phenergan ( I wouldn't expect cross-reactivity, but another H1 could lead to more EPS-like side effects)
elclo
3 Posts
I had a patient today that came for routine tests at clinic. Patient lips swollen on R side. According to patient he received phenergan 25mg from pharmacy 2 hours earlier and drank 2 tablets. After aprox 15 minutes swelling got worse. Tongue not swollen, patient didnt struggle to breathe. I gave 1ml of 1:1000 of Adrenaline. Swelling of lips didnt improve, patient didnt want to stay as he was in s hurry. Your thoughts on this patient? Anything else that I could have done for this patient?