Epinephrine
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Lack of efficacy: case report In a case series, a 25-year-old woman was described, who exhibited a lack of efficacy during treatment with epinephrine for low blood pressure. The woman (at 28 weeks and 6 days of gestation), who was in her third pregnancy, presented at the hospital with a 5-day history of upper respiratory symptoms, myalgia, fever and diarrhoea. Afterwards, her condition worsened with intense fatigue and a nonproductive cough. No comorbidities were reported. However, her husband had a fever 24h previously after contact with Covid-19 positive patients. Hence, she was transferred to the ICU. Subsequently, she started receiving hydrocortisone 2g for the acceleration of foetal lung maturation. She had received azithromycin, ceftriaxone, oseltamivir and enoxaparin in standardized doses. During hospitalisation, she required mechanical ventilation. Her oxygen saturation was 94%, and the initial leukogram revealed 4000 WBC with 11% lymphocytes. The reverse transcription-polymerase chain reaction (RT-PCR) test showed a positive result for SARS-CoV-2 infection. Therefore, she started receiving off-label treatment with hydroxychloroquine 400mg twice daily (initial dose), followed by 400mg once daily for 5 days. Because of her critical condition and severe oligohydramnios, she underwent C-section, and subsequently, she delivered a female neonate. Her neonate’s weight was 1255g, and the Apgar score was 6 and 7 at 1 and 5 minutes, respectively. The neonate tested negative for Covid-19 and was transferred to the neonatal ICU because of extreme prematurity. The neonate had received unspecified systemic antibiotic therapy for right hemithorax atelectasis. The mother remained in the ICU for 22 days and was treated with off-label meropenem 500mg thrice daily, vancomycin 1g twice daily and polymyxin-B. She also required intubation and mechanical ventilation. During hospitalisation, her LDH level increased to 524 U/L. She had received continuous epinephrine drip [route and dose not stated] for low blood pressure. However, her BP further decreased to 60/40mm Hg. The woman’s condition worsened with irreversible refractory shock and multiple organ failure, and subsequently, she died [exact cause of death not stated]. Her blood cultures revealed negative results. Dos Reis HLB, et al. Severe coronavirus infection in pregnancy: Challenging cases report. Revista do Instituto de Medicina Tropical de Sao Paulo 62: 1-5, 2020. Available 803502995 from: URL: http://doi.org/10.1590/S1678-9946202062049
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Reactions 26 Sep 2020 No. 1823
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