Angioedema

T78.3 + (Y14.99/Y34.99/Y57.9)

• Description
• General measures
• Medicine treatment
• Referral

DESCRIPTION

Localised oedema of the subcutaneous tissue affecting particular parts of the face i.e. lips, eyes and tongue. May also affect the larynx, causing life threatening airway obstruction and anaphylaxis.
ACE-inhibitors are the most common cause in adults.
Other causes include other medicines and allergies.

GENERAL MEASURES

• Stop all suspected agents e.g. ACE-inhibitor.
• In the case of airway obstruction, a definitive airway must be established if oedema is extensive or progressing.

MEDICINE TREATMENT

In severe cases where airway obstruction is present:

Adults

• Adrenaline (epinephrine), 1: 1000 solution, 0.5 mL into the lateral thigh, administered immediately and repeated every 5 to 15 minutes as needed.

Children

• Adrenaline (epinephrine), IM, 0.01 mL/kg of 1:1000 solution, administered immediately.
  • Maximum dose of 0.3 mL

In all cases

AND

• Hydrocortisone, IV, 100 mg as a single dose

If urticaria and/or itch present (no imminent airway compromise):

LoE:III

• Cetirizine, oral, 10 mg as a single dose.

OR

• Promethazine, IM, 25–50 mg immediately.

CAUTION
Do not give an antihistamine to children < 2 years of age.

Observe all cases until resolution.

REFERRAL

• Failure to respond.
• No obvious cause found.
• Severe ACE-inhibitor induced angioedema.