ANAPHYLACTIC SHOCK FOLLOWING INTRAMUSCULAR THIAMINE CHLORIDE

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Abstract
Following intra-muscular injection of 1 ml of 20% thiamine, a 62-year-old man was hospitalized in acute cardiorespiratory distress. A half hour prior to his 2d hospital admission in Sept., 1949 he had received 1 ml of coramine, 0.5 mg of digitoxin by mouth, and sublingual nitroglycerine from a physician who had been treating him with "liver injections" for 1 month. Gradually his dizziness, palpitations, and sharp precordial pains subsided, while the flush over his obese body slowly disappeared. There were no known allergies. Within 5 days he was discharged improved with the diagnosis of acute poisoning thought to be due to thiamine chloride. He was readmitted on Aug. 6, 1954 with signs and symptoms of a minor cerebral vascular accident. A week later he was given intramuscular injection of thiamine hydrochloride (100 mg of Betaxin) and within 5 minutes suffered symptoms of anaphylactic shock. Twenty minutes after receiving O2 by nasal catheter, Levophed intravenously, and aminophylline intramuscularly, his blood pressure was recorded as 90/60 mm Hg. Shortly thereafter atropine, Benadryl, ephedrine sulfate, and Pyribenzamine were employed. The patient was discharged in good health on Aug. 25, 1954 with the following diagnoses: generalized arteriosclerosis, questionable thrombosis of the right middle cerebral artery due to unspecified cause, and anaphylactic shock secondary to thiamine chloride hypersensitivity. This case fulfilled the necessary criteria for anaphylaxis: sensitization to thiamine chloride, a period of latency, and 2 immediate generalized reactions upon separate re-exposures to the same potential antigen. The toxic-reaction theory proposed in 1952 by Jaros, Wnuck, and de Beer was reviewed. At that time, their recommended treatment of reactions to thiamine chloride was epinephrine. Norepinephrine supplemented by spasmolytic and antihistaminic agents was used effectively in this case.

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