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Anaphylaxis – refractory — RACP Paediatrics MCQ

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HardEmergencyAnaphylaxis – refractoryRACP Paediatrics

A 4-year-old with food-triggered anaphylaxis remains hypotensive and wheezy five minutes after correctly dosed IM adrenaline. He is supine, receiving oxygen and has IV access. Which immediate combination is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Give IM adrenaline 10 micrograms/kg plus 0.9% saline 20 mL/kg

D is correct. Persistent airway or circulatory features after five minutes require another age-appropriate IM adrenaline dose, while hypotension from capillary leak requires rapid 0.9% saline 20 mL/kg and reassessment. E delays the life-saving therapies; corticosteroids are not routine acute treatment. A uses a dangerous cardiac-arrest-range IV bolus and the wrong resuscitation fluid. B may be added for bronchospasm but cannot replace adrenaline or volume resuscitation. C neither treats shock nor justifies fluid restriction. Escalating oxygen, monitoring and early critical-care or retrieval support proceed in parallel; refractory anaphylaxis is considered after two appropriate IM doses.

Reference: Royal Children’s Hospital Melbourne: Anaphylaxis: https://www.rch.org.au/clinicalguide/guideline_index/anaphylaxis/ Royal Children’s Hospital Melbourne: Anaphylaxis flowchart: https://www.rch.org.au/uploadedFiles/Main/Content/clinicalguide/anaphylaxis_flowchart.pdf