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Diagnosing DIRD
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The Drug-Induced Respiratory Disease Website
Philippe Camus, M.D.
Dijon, France
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Drugs
Patterns
General anesthesia
3
X.f
Anaphylaxis-Anaphylactoid reaction (can be fatal)
2
Last update :
25/03/2014
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Identify causative drugs
Diagnosing DIRD
1
Drug and radiation history
2
Drug singularity - Correct identification of the drug
3
Consistent timing of exposure v. onset of symptoms
4
Clinical, imaging, BAL, pathological pattern consistent with the specific drug
5
Careful exlusion of another cause
6
Remission of symptoms with removal of drug
7
Recurrence with rechallenge (rarely advisable)
8
Causality assessment
More detailed checklist
See also under
Colloids
Crystalloids
Dyes
Ethosuximide
Ethylene-vinyl alcohol copolymer (e.g. Onyx (R))
Fentanyl
Fluorescein
Forceful inspiration against a closed glottis or airway
Fresh frozen plasma
Gases
Gelatin
Hemotherapy (transfusion/infusion of whole blood, red cells, platelets, or blood products)
Heparin
Inhalants (volatile substances)
Ketamine
Lepirudin
Lipiodol - Iodinated/iodized oil (RCM)
Liposuction
Macro-aggregated albumin (& 99Tc tagged)
Methacrylate - Methylmethacrylate
Methylene blue
Microspheres
Morphine
Neuromuscular blocking agents (NMBA-NMBD)
Nitric oxide (NO)
Nitrites - Nitrates ('Poppers')
Opiates - Opioids - Opium
Oxygen (dioxygen, O2)
Pancuronium
Patent blue
Plasma
Pulmonary hypertension therapy
Sevoflurane
Sufentanil
Sugammadex
Thiopental
Thrombolytic (fibrinolytic) agents
Transhepatic arterial chemoembolization (TACE)
Vertebroplasty (kyphoplasty)
Publications
Suspected recurrent anaphylaxis in different forms during general anesthesia.