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Red man syndrome related to vancomycin

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柾 巓

Red man syndrome (RMS) is a potential adverse reaction related to vancomycin administration. Symptoms include flushing, erythema, and pruritus of the upper body as well as chest or back pains and hypotension. Differential diagnosis includes anaphylaxis, which features wheezing, dyspnea, and angioedema. RMS is caused by vancomycin activating mast cells. Risk factors include certain antibiotics, opioids, plasma expanders, and mastocytosis. RMS can be prevented by administering vancomycin at concentrations less than 5 mg/ml at rates less than 10 mg/min, and premedicating with diphenhydramine and famotidine. Treatment involves

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"Red man syndrome" (RMS) related to vancomycin ﾊ郭u浩垢恬兄 巓柾
Symptoms of RMS ? Flushing, erythema, and pruritus, usually of the upper body. ? Chest or back pains and hypotension may also occur.
Differential diagnosis ? Symptoms of anaphylaxis overlap with those of severe RMS, although wheezing, significant dyspnea, and angioedema are more suggestive of anaphylaxis.
Mechanism of RMS ? Activate mast cells
Predisposing factors ? (Drugs) ? Antibiotics (ciprofloxacin) ? Opioids (eg, morphine, meperidine, codeine) ? Plasma expanders ? Radiocontrast dye ? Muscle relaxants used in general anesthesia ? Barbiturates ? (Diseases) Mastocytosis
Prevention of RMS ? (Administration) ? conc.＋5mg/ml and rate＋10mg/min ´.eg. 1 g in 200ml NS or D5W, drip over >100 min ? (Premedication) ? Diphenhydramine (50 mg orally) ＼ famotidine (20 mg orally) 1 hour before infusion
Treatment ? Stop infusion ? Diphenhydramine (50 mg IV) ＼ famotidine (20 mg IV) ? Intravenous fluids may be needed for hypotension ? Afterwards, re-infusing any subsequent doses of vancomycin over four hours
Q1 ? Loading vancomycin 1g,￣恷富￣勣喘謹富 N/S蓮? ? (A) 50ml ? (B) 100ml ? (C) 200ml ? (D) 500ml ? C
Q2 ? Loading vancomycin 1.5g,￣恷富￣勣砧謹 消rg? ? (A) 50min ? (B) 1hr ? (C) 2hr ? (D) 2.5hr ? D
Q3 ? Vancomycin 0.5g q8h,嗤壓捲喘ultracet 1tab tid,vancomycin秀h砧謹消rg? ? (A) 100min ? (B) 50min ? (C) 30min ? (D) 10min ? A

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Red man syndrome related to vancomycin

  • 1. "Red man syndrome" (RMS) related to vancomycin ﾊ郭u浩垢恬兄 巓柾
  • 2. Symptoms of RMS ? Flushing, erythema, and pruritus, usually of the upper body. ? Chest or back pains and hypotension may also occur.
  • 3. Differential diagnosis ? Symptoms of anaphylaxis overlap with those of severe RMS, although wheezing, significant dyspnea, and angioedema are more suggestive of anaphylaxis.
  • 4. Mechanism of RMS ? Activate mast cells
  • 5. Predisposing factors ? (Drugs) ? Antibiotics (ciprofloxacin) ? Opioids (eg, morphine, meperidine, codeine) ? Plasma expanders ? Radiocontrast dye ? Muscle relaxants used in general anesthesia ? Barbiturates ? (Diseases) Mastocytosis
  • 6. Prevention of RMS ? (Administration) ? conc.＋5mg/ml and rate＋10mg/min ´.eg. 1 g in 200ml NS or D5W, drip over >100 min ? (Premedication) ? Diphenhydramine (50 mg orally) ＼ famotidine (20 mg orally) 1 hour before infusion
  • 7. Treatment ? Stop infusion ? Diphenhydramine (50 mg IV) ＼ famotidine (20 mg IV) ? Intravenous fluids may be needed for hypotension ? Afterwards, re-infusing any subsequent doses of vancomycin over four hours
  • 8. Q1 ? Loading vancomycin 1g,￣恷富￣勣喘謹富 N/S蓮? ? (A) 50ml ? (B) 100ml ? (C) 200ml ? (D) 500ml ? C
  • 9. Q2 ? Loading vancomycin 1.5g,￣恷富￣勣砧謹 消rg? ? (A) 50min ? (B) 1hr ? (C) 2hr ? (D) 2.5hr ? D
  • 10. Q3 ? Vancomycin 0.5g q8h,嗤壓捲喘ultracet 1tab tid,vancomycin秀h砧謹消rg? ? (A) 100min ? (B) 50min ? (C) 30min ? (D) 10min ? A