Reaction to rocephin

MunoRN, RN · Nov 18, 2015

Acute hypotension is an expected part of anaphylactic shock and along with airway constriction is what makes it acutely life threatening. Hives is typically a late sign which is clinically useful because it may be the only obvious symptom from the first exposure to a substance someone is allergic to, but should be taken seriously because further exposures could potentially be far more acute anaphylaxis.

In a chronic drinker who hasn't had a drink in a few days, their seizure threshold is already reduced, hypotension and an acute inflammatory response could be what tips the balance. Ativan or diazepam would certainly help treat and prevent the possible seizure activity, and epi will help counteract the effects of shock, but the patient could also benefit from anti-histamines; benadryl, famotidine as well as steroids if needed.

Been there,done that, ASN, RN · Nov 18, 2015

I've always viewed rocephin as one of the safer antibiotics considering how quickly we give it.
this pt had a rapid onset after starting an IVPB. Flushed skin, diaphoresis, sorta syncopal/half seizure and immediate hypotension. She reported being a drinker prior to this and states she hadn't had a drink in several days.
i have trouble not believing it was the rocephin as it happened immediately after.
just curious if others had seen a reaction like this before. We managed to stabilize her and put her into a higher acute observation area.
Im used to more typical symptoms hives/stridor. I've seen the diaphoresis and flush, it was the seizure/syncopal reaction part that threw me off. I was almost wondering if Ativan might have been a better option in combo with Epi as opposed to Benadryl.
im open to suggestions and would appreciate others input. Thanks!

"one of the safer antibiotics considering how quickly we give it."

A similar reaction to Red Man Syndrome. There is no need to rapidly infuse antibiotics. Slow it down and give the body a chance to deal.

jadelpn, LPN, EMT-B · Nov 18, 2015

If the patient has a penicillin allergy, I have seen this before.

The drinking or lack thereof--a co-morbidity that needs monitoring. And treatment if indicated separate from the Rocephin issue.

I have seen Rocephin given as injections and IV. IV was I think a 30 minute infusion. If you are straying from the recommended time, I would make sure you have an order for that. ie: to be given over 1 hour, for instance. And going forward, this patient would perhaps need to be premedicated so it doesn't happen again--or given another antibiotic.

**NickiLaughs, ADN, BSN, RN** · Nov 18, 2015

No known allergy history. We gave Benadryl, Epi and zofran for vomiting. I was thinking Ativan may have helped. The hypotension I expected and already had hung 2l wide open and obtained a second large bore IV. Just had never seen such a reaction with rocephin but there is a first time for everything. In the ER I work we've given it IM or IVPB. I don't know how you would slow down an IM injection. This was IVPB on a pump. Good learning moment for me though. I agree with the potential of causing a alcohol withdrawal seizure which initiated from the stress of an allergic reaction. It just was atypical.

**NickiLaughs, ADN, BSN, RN** · Nov 18, 2015

we weren't made aware of the potential alcohol withdrawal until after she was in our fast track area. She displayed no signs of withdrawal and I asked the doc if we should move her to another area in case she started displaying symptoms, but the entire ER was slammed and there was nowhere to put her at that time. So plan was to watch for withdrawal symptoms and if she started, then we'd push strongly for the next monitored bed.

The order was for 30 mins, I was giving it over 30 minutes. In about 7 minutes she began to react. I was referring to how fast it's given when compared to other antibiotics. Vanco is usually given over an hour to two hours and it dosage is based on the patients weight. Red mans syndrome happens because people don't use a pump or its too large a dose for a patient usually.

I don't think there is much else I could have done differently other than push for Ativan perhaps, but I was looking for others who had encountered a similar reaction and their insight on it

CrunchRN, ADN, RN · Nov 18, 2015

Have seen all of that even with a vagal reaction to a blood draw.

IVRUS, BSN, RN · Nov 23, 2015

I believe what you witnessed here was Speed Shock. Whenever a foreign substance, in this case IV Rocephin, is given too rapidly, the body can develop this malady.

RedneckRedman Syndrome is unique to Vancomycin and can be seen when Vanc is given too quickly.

You say that the medication was to be given over 30 minutes and that that is what you were doing... But were you giving it on a Pump, or just counting drops?

**NickiLaughs, ADN, BSN, RN** · Dec 23, 2015

Pump. We always do a pump. She ended up going to ICU. I'm one of those people that slow IVP every drug and I'm pretty against giving anything too fast. Never heard of the term speed shock but I will def continue my practice of slow med administration (except in codes and cases of SVT) . I just was thrown off because I've given rocephin hundreds of times and this was my first reaction. But I guess if you give any drug enough you will eventually encounter something....