Intralingual epi?

[zzyzx]

I've read a couple of case reports of epi administered intralingually for anaphylaxis. In these cases the patients had very swollen tongues and were airway compromised or in danger of being so.

Just wanted to get some thoughts on this from you folks...

 

[medicdan]

I've read a couple of case reports of epi administered intralingually for anaphylaxis. In these cases the patients had very swollen tongues and were airway compromised or in danger of being so.

Just wanted to get some thoughts on this from you folks...

I'm curious where you've read that, I'd love to read as well.

We discussed this a few weeks ago (and continuing until recently)... http://www.emtlife.com/showthread.php?t=37982

 

[KellyBracket]

There has been research looking at sublingual tablets of epinephrine, but no studies of injected epi, as far as I know.

A column in EMS World recently described using a sublingual injection, but didn't discuss any evidence, or provide any references.

On the other hand, we have fairly good studies looking at epi pharmacokinetics in SQ versus IM administration in the thigh, and some good clinical data looking at the great safety profile of IV epi administered as a drip (not a bolus).

 

[zzyzx]

Wow, two replies after just 10 minutes of my post, and on Xmas!

Sorry, I didn't realize something similar was discussed on another thread.

Yeah, I read about it in a recent magazine article. There was also an article in another EMS magazine about a year or two ago in which they discussed a case where a woman who had been stung in the tongue by a wasp was given intralingual epi. Sorry, but I don't have links to those articles.

These article got me thinking. I can see advantages to administering epi intralingually. One being that you would quickly get local vasoconstriction of the swollen tongue. The other being that intralingual absorption might be faster than IM into the thigh (?). One drawback would be that if I were a patient, I don't think I'd want someone sticking a needle into my tongue.:blink:

 

[KellyBracket]

The advantages you mention are only theoretical, even if they are appealing. Go with the evidence we already have.

For the safety of an IV epi drip protocol, read http://www.ncbi.nlm.nih.gov/pubmed/14988337. Open access. For the benefit of IM versus SQ, check out my brief review (with a great graph), at http://millhillavecommand.blogspot.com/2012/08/new-guidelines-for-anaphylaxis.html

 

[zzyzx]

I just read the abstract from PubMed. It is interesting that some patients developed not only hypotension but also a relative bradycardia, and that two of them were actually given atropine.

 

[KellyBracket]

The whole article should be open access through pubmed. Yeah, it's fascinating stuff, really counter-intuitive. Appears to be some direct effect of anaphylaxis on the myocardium.