Anaphylactic shock associated with intravenous amiodarone

AbstractA 64-year-old woman was admitted to our emergency department with shortness of breath and palpitation which started 2h before her admission. She had a history of rheumatic mitral valve disease and was on drug treatment with warfarin and metoprolol. The patient was orthopneic, blood pressure was 108/68mmHg with an irregular pulse with a heart rate of 158 beats per minute, and respiratory rate was 23 times per minute. Her electrocardiogram was consistent with atrial fibrillation with rapid ventricular response. For pharmacological cardioversion the patient was given amiodarone intravenous loading dose of 300mg in 30min. After 10min of infusion the patient complained of pruritus and skin rash consistent with urticaria. At the same time the patient had dyspnea and bronchoconstriction was noted on both lung fields. The blood pressure was measured as 64/40mmHg. The patient was taken to intensive care unit and supportive treatment for anaphylactic shock was given. Amiodarone is a class III antiarrhythmic agent frequently used in the management of atrial fibrillation. This potentially fatal complication of amiodarone should be kept in mind by clinicians and before administration patients should be questioned about previous allergic reactions including previous iodine or iodinated contrast media. Alternative agents should be considered in these conditions.