Laryngeal oedema

Hereditary angioedema, with deficiency of Cj-esterase inhibitor (a complement inhibitor), may not respond to antihistamines or corticosteroid but only to fresh frozen plasma or preferably Cj-inhibitor concentrate. Delay in initiating the treatment may lead to death from laryngeal oedema (try adrenaline (epinephrine) i.m. in severe cases). For long-term prophylaxis an androgen (stanozolol, danazol) can be effective. 

Botma M, Colquhoun-Flannery W, Leighton S. Laryngeal oedema caused by accidental ingestion of oil of wintergreen. Int J Pediatr Otorhinolaryngol 2001 58(3) 229-32. 

Silfvast T, Kinnunen A, Varpula T. Laryngeal oedema after isosorbide dinitrate spray and sublingual nifedipine. 

Rhinorrhoca, often profuse, is commonly seen after vapour exposure. Epistaxis may occur in severely affected patients. Inflammation and ulceration of the palate, nasopharynx, oropharynx and larynx follow, the voice becomes hoarse and temporary aphonia may occur. Reports from World War I suggest that laryngeal oedema and/or spasm sufficiently severe to necessitate tracheostomy occurred very seldom. 

Colourless viscous liquid with a chloroformlike odour. Rapidly absorbed all routes. Strong respiratory irritant. Inhalation bronchospasm, laryngeal oedema, chemical pneumonitis, pulmonary oedema. Skin erythema, blistering. Oral nausea, vomiting, weakness, headache, brady/tachycardia, oliguria, jaundice, confusion,... 

Respiratory Bronchospasm, laryngeal oedema or rarely laryngospasm... 

Formaldehyde is a pungent irritating colourless gas, readily soluble in water resulting in a caustic solution. Irritation of the eyes and throat leads to lachrymation and coughing, respectively. In severe cases laryngeal oedema may develop. 

Choking agents Chlorine characteristic Phosgene hay/mown grass Chlorine rapid onset mild (more severe over hours Phosgene 1-24 h Sore throat/painful eyes throat/chest tightness dyspnoea wheeze Laryngeal oedema/inflamed throat pulmonary oedema Upper airway sepsis... 

Skin rashes may occur (79 —81 , 82 ). With glafenine severe anaphylactic shock with cardiovascular collapse and loss of consciousness has been reported on several occasions (83 , 84 -, 85 ). The reaction usually develops suddenly within 20—30 minutes of ingestion of one or two tablets, and there may be generalized erythema, facial and laryngeal oedema, abdominal pain and profuse diarrhoea (SS ). An unusual reaction consisting of lymphadenopathy fever, rash and eosinophilia has also been attributed to glafenine (82 -, 88 -). Mefenamic and flufe-namic acids may cause bronchoconstriction in asthmatic patients with aspirin sensitivity (25C). 

Salfan is an injectable anaesthetic for use in cats although it has also been used in other small animals. In cats, it may produce oedema of the ears and paws following a dmini stra ti on. 445 However, the most serious effects were laryngeal and pulmonary oedema which were occasionally severe and resulted in the deaths of affected cats. " This appears to be due to the release of histamine or a histamine-like substance caused by the solubilising agent Cre-mophor EL, a polyethoxylated castor oil derivative used in the formulation. 

A further approach in antidote management is to use chelating compounds which actively bind the cyanide and are then excreted in the urine. The main agent in use is Kelocyanar (dicobalt edetate). Careful consideration should be given before this antidote is used. If there has been no exposure to cyanide, there may be serious adverse effects include vomiting facial, laryngeal and pulmonary oedema anaphylaxis, severe hypotension. 

Dicobalt edetate is significantly toxic in itself and may cause vomiting, tachycardia and hypotension as well as anaphylactic reactions, including facial, laryngeal and pulmonary oedema. 

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