Schwerer Zwischenfall nach i.v.-Applikation von 10 ml (0,6 g) 6%igem Dextran60 bei einem gesunden Probanden

We describe the case of a 24-year-old healthy volunteer who underwent a dextran-induced anaphylactic/anaphylactoid reaction (DIAR) type III after administration of 10 ml 6% Dextran60 (0.6 g) during a preliminary examination.There were no specific incidents in the medical history or any infusions of any colloids. In contrary to other DIAR case reports of anaphylactic reactions, in this case we observed a latency period after intravenous application of Dextran60 to the first clinical symptoms of anaphylactic shock of about 5 min.The initial decrease of systolic blood pressure to less than 90 mmHg and consecutive increase in heart rate to higher than 90 bpm returned to normal after therapy with head-down position, iv injection of2 mg Clemastin, 100 mg hydrocortisone and infusion of 500 ml hydroxyethyl starch after approximately 8 min. During this period responsiveness was unsatisfactorily although the volunteer complained about warming of the skin, paresthesia and nausea. Immediate shock symptoms that normally belong to antigen-antibody reactions were not observed. It is therefore still unclear whether this case was caused by antibody reactions. Nevertheless, to provide DIAR it is still absolute necessary to give 20 ml Promit® 15% in advance. It is not an acceptable alternative to infuse the first 100 ml of dextran as a bolus and it must remain a point of discussion as to whether the reactions described could have been due to a bolus administration of the first 100 ml Dextran. It is absolutely necessary to accurately monitorthe first 10 min after an infusion even if only small volumes of dextran (i.e. 0.6 g) are infused.This is becoming more and more important due to the increasing use ofsmall volume resuscitation, solutions containing dextran (RescueFlow®, Biophausia AB, Uppsala, Schweden) or cryoconservation with dextran.