Asia Pac Allergy.  2015 Jan;5(1):47-50. 10.5415/apallergy.2015.5.1.47.

Refractory intraoperative hypotension with elevated serum tryptase

• Sprung J
• Larson KJ
• Divekar RD
• Butterfield JH
• Schwartz L
• Weingarten TN

• KMID: 2397067
• DOI: http://doi.org/10.5415/apallergy.2015.5.1.47

Abstract

Severe intraoperative hypotension has been reported in patients on angiotensin-converting enzyme inhibitors and angiotensin II receptor subtype 1 antagonists. We describe a patient on lisinopril who developed refractory intraoperative hypotension associated with increased serum tryptase level suggesting mast cell activation (allergic reaction). However, allergology workup ruled out an allergic etiology as well as mastocytosis, and hypotension recalcitrant to treatment was attributed to uninterrupted lisinopril therapy. Elevated serum tryptase was attributed to our patient's chronic renal insufficiency.

Keyword

Anaphylaxis; Renal insufficiency, Chronic; Hypotension; Lisinopril; Mastocytosis; Tryptase

MeSH Terms

Anaphylaxis
Angiotensin-Converting Enzyme Inhibitors
Humans
Hypotension*
Lisinopril
Mast Cells
Mastocytosis
Receptors, Angiotensin
Renal Insufficiency, Chronic
Tryptases*
Angiotensin-Converting Enzyme Inhibitors
Lisinopril
Receptors, Angiotensin
Tryptases

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