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Lack of efficacy: case report An 11-year-old boy exhibited lack of efficacy during treatment with dopamine and epinephrine for hypotension and shock. The boy who had tactile fever, diffuse erythematous pruritic maculopapular rash, sore throat, emesis and decreased urine output presented for the admission into paediatric ICU. For these complaints, he was hospitalised in an outside hospital, where he was discharged with ibuprofen, amoxicillin and clindamycin at that time. During current admission, he was found to be febrile, tachycardic, tachypneic and normotensive with a BP of 114/57mm Hg and oxygen saturation of 99% on room air. Thereafter, he became progressively hypotensive requiring fluid resuscitation and developed shock. To maintain BP, he received inotropic support with dopamine and epinephrine [routes and dosages not stated]. Meanwhile, he received empiric treatment with clindamycin, piperacillin/tazobactam and linezolid. His hypotension and shock did not improve on dopamine and epinephrine (lack of efficacy). For presumptive toxic shock syndrome, he later received two doses of IV immune-globulin (IVIG). Additionally, due to vasopressorrefractory shock, he received hydrocortisone on hospital days 2 to 7. Later, he was diagnosed with Kawasaki shock syndrome (KSS). He then initiated on high-dose aspirin and clopidogrel. Derespina KR, et al. Pediatric Shock: An Uncommon and Underrecognized Etiology. Journal of Pediatric Intensive Care 9: 210-212, No. 3, Sep 2020. Available from: URL: 803507271 http://doi.org/10.1055/s-0039-1700964

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Reactions 17 Oct 2020 No. 1826