Anaphylaxis shock due to penicillin is a case study for practicing veterinarians and students, who will able to describe the mode of action of prescribing drugs.

1. Dr. Jibachha Sah, M.V.Sc, Lecturer Veterinary pharmacology, NPI, Chitwan, Nepal
Anaphylaxis shock from penicillin
(A case study of mode of action of drug for practicing veterinarian and students)

2. Case study
A 5 year old Holstein-Friesian cow was given an intramuscular injection
of combined penicillin and streptomycin to treat wound in the leg.
Before injection, clinical
finding were normal and were
as follows:
Body temperature: 38.5 0C
HR: 80(bpm),RR:20(bpm),RM
4 (cp5m)

3. Less than a minute following the injection cow showed:
Severe dyspnea, incoordination, anxiety, salivation, urticaria,
facial and pereneal oedema, lacrimation, rhinitis, and shock.
Elevation of body temperature(40oC),HR(132bpm),RR(32bpm)and
RM(1 cp 5 minute).

4. Section Break
Insert the Subtitle of Your Presentation
Severe facial edema especially around the
eyes(fascial-conjunctival angioedema) and
lacrimation observed within minutes of IM
injection of penicillin-streptomycin).
Urticaria on the caudal surface o
the mammary gland: a- immediately
after intramuscular injection o
peniciilin-sreptomycin,b-20 h afte
treatment,c-40 h after treatment
Note the decrease in redness from
a to c

5. Edema in the anal and external genital area: a –
within minutes of intramuscular injection of
penicillin and streptomycin, b- recovery 20 h after
treatment
Severe dyspnea and rhinitis: a- immediately after injection with
penicillin-streptomycin, b-recovery 20 h after treatment

6. The first organ to be affected by anaphylactic shock in dogs is usually the liver, which
causes extreme upset to the digestive system. Unlike humans, and cattle, dogs may
not exhibit signs of swelling in the face or throat in some cases.
Anaphylaxis shock in dog

7. ●Vomiting
● Diarrhea
● Pale gums
● Cold limbs
● Excessive salivating or drooling
● Wheezing and difficulty breathing
● Increased heart rate or a weak pulse
● Seizures
● Shock
● Coma
Symptoms of a severe allergic reaction in dog

8. Few less intense signs of allergic reaction in dog
●Skin problems like hives, swelling, bumps, rashes, or itchy areas
● Congestion
● A dry, chronic cough
● Difficulty breathing during exercise
● Vomiting after eating certain foods

9. Treatment in dog and cattle
In specific pharmacotherapy, the following substances have proven to be effective:
●Vasoactive substances- Adrenaline
● Oxygen- Administration of high flow 100 % oxygen is recommended.
● Volume substitution- Primarily, normal saline (NaCl 0.9 %) or balanced electrolyte solutions should
be used. a supply of 0.5–1 liters, and possibly up to 2–3 liters of fluid

10. Epinephrine administered intramuscularly is often
immediately effective.
Dose
0.2–0.5 mg (total dose) SC or IM
0.01–0.1 mg/kg IV
Choice of drug for treatment in dog and cattle
Corticoids are said to potentiate the effective of
epinephrine and may given immediately following
epinephrine in order to maintain vascular integrity
and to decrease permeability of pulmonary vessels.
0.1–0.5 mg/kg IV

11. Question

14. Epinephrine
As an α- and β-agonist, epinephrine is essential in the treatment of anaphylaxis. It has the following effects:
●α-adrenergic effects. Vasoconstriction, which increases vascular resistance and
thus blood pressure and coronary perfusion, and decreased edema, which leads to
relief of upper airway obstruction
● β1-adrenergic effects. Positive inotropic and chronotropic activity, leading to
increased cardiac output
● β2-adrenergic effects. Bronchodilation, leading to increased tissue oxygenation;
also, the rate of adenosine triphosphate hydrolysis into adenosine monophosphate
increases, which results in inhibition of histamine and cytokine release from mast
cells and basophils, truncating the type 1 hypersensitivity reaction