Este protocolo aborda el manejo del síndrome de enterocolitis inducida por proteínas alimentarias (FPIES) agudo grave en una presentación definida por más de tres episodios de emesis acompañados de letargo grave, hipotonía y un aspecto cutáneo ceniciento o cianótico.
DOI: 10.1016/j.jaci.2016.12.966
>3 Episodes of emesis, with severe lethargy, hypotonia, ashen or cyanotic appearance
Place a peripheral intravenous line and administer normal saline bolus, 20 mL/kg rapidly; repeat as needed to correct hypotension
The priority in management of severe FPIES is restoration of stable hemodynamics through aggressive isotonic fluid resuscitation (eg, 10-20 mL/kg boluses of normal saline) repeated as needed and dextrose saline as a continuous intravenous maintenance infusion (Table VI).
In severe reactions patients might require supplemental oxygen, mechanical ventilation, or noninvasive positive pressure ventilation for respiratory insufficiency or failure, vasopressors for hypotension, bicarbonate for acidemia, and methylene blue for methemoglobulinemia.
Monitor and correct acid base and electrolyte abnormalities. Correct methemoglobinemia, if present. Discharge after 4-6 h from the onset of a reaction when the patient is back to baseline and is tolerating oral fluids.
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