A 7-year-old child in anaphylactic shock has received intramuscular epinephrine and two fluid boluses but remains hypotensive with persistent bronchospasm. The second-line vasopressor of choice for refractory anaphylactic shock in pediatric PALS is:

• A Norepinephrine infusion
• B Glucagon IV bolus followed by infusion ✓
• C Vasopressin infusion
• D Dopamine infusion

Explanation

Glucagon is specifically recommended for refractory anaphylaxis, particularly in patients on beta-blockers where catecholamines may be ineffective, because it acts via non-adrenergic adenylyl cyclase pathway. It reverses both bronchospasm and hypotension. While vasopressors like norepinephrine may be added, glucagon addresses the underlying mechanism when epinephrine response is inadequate. Vasopressin and dopamine are used in septic shock but are not the preferred second-line agents for anaphylaxis.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.