Ten minutes after receiving DPT vaccine, a 6-week-old infant develops generalized urticaria, stridor and difficulty breathing. The health worker decides to give adrenaline. The correct immediate management is:
- A Chlorpheniramine maleate orally and observation for 6 hours without injectable drugs
- B Hydrocortisone 100 mg intravenously as the first drug, with adrenaline withheld
- C Adrenaline 0.01 mg/kg intramuscularly in the anterolateral thigh, maximum 0.5 mg, repeated if needed ✓
- D Subcutaneous adrenaline 1 mg undiluted, repeated every minute until symptoms resolve
Correct answer: C. Adrenaline 0.01 mg/kg intramuscularly in the anterolateral thigh, maximum 0.5 mg, repeated if needed
Explanation
This is anaphylaxis, and intramuscular adrenaline at 0.01 mg/kg (maximum 0.5 mg adults, 0.3 mg children under 12 years) into the anterolateral thigh is the first-line treatment, repeatable every 5 to 15 minutes. Antihistamines and steroids are adjuncts with slow onset and must never delay adrenaline. C 1 mg undiluted subcutaneous dose risks severe hypertension and arrhythmia and is not the recommended regimen.
Reference: Park's Textbook of Preventive and Social Medicine, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.