FATAL BROMSULPHALEIN REACTION

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Abstract
Bromsulphalein toxic reactions with serious consequences are rare. No fatalities have been previously reported. The occurrence of a fatal reaction to bromsulphalein in patient whose liver function was being re-evaluated is therefore being documented. A bromsulphalein retention of 20% in one hour was recorded 4 months previously. Several minutes after 9.5 cc of a 5% solution of bromsulphalein were injected slowly intravenously the patient complaied of a headache, became cold and clammy, pulseless, and expired suddenly before any emergency measures could be given. The clinical picture and necropsy findings leave little doubt that bromsulphalein was an immediate constitutional sensitizing substance that caused a fatal reaction in this case. This incident bears out the fact that no diagnostic test or drug can be used without some risk. Precautionary measures are difficult to evaluate. However, it is suggested that when indicated bromsulphalein should be administered intravenously slowly by the clock over a period of 5 minutes. If an allergic diathesis is suspected, a skin test may be advisable before a bromsulphalein test is repeated. In addition, an epinephrine solution 1:1000 should be available for immediate use if necessary at the patient''s bedside.
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