“Badly Swollen Lips…” Case Conclusion November 7, 2012

Posted by Andy Jagoda, MD in: Gastrointestinal, Respiratory Emergencies , add a comment

The patient with the lip swelling was able to tell you later that the medication he takes is lisinopril. You realized that the diphenhydramine, cimetidine, and prednisone that you already gave him were unlikely to change his clinical course; however, you were reassured that despite how impressive his lip swelling may have been, this would be considered Ishoo stage I and thus unlikely to need airway intervention. You decided to observe him in the ED. After 6 hours, he had marked improvement. You decided to discharge the patient after contacting his primary care provider who would be able to see him the next afternoon. You instructed the patient that the lisinopril is most likely the cause of his swelling and that he should never take this medication or any medication of the same class again.

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Badly Swollen Lips… October 30, 2012

Posted by Andy Jagoda, MD in: Gastrointestinal, Respiratory Emergencies , 17 comments

In the middle of an unusually slow evening shift, a 52-year-old black male presents to the ED from walk-in triage with a complaint of lip swelling. He states that he noticed a tingling in his lips shortly after waking that morning, but it wasn’t until he brushed his teeth that he noticed how large his lips had become. He decided to come to the hospital almost 12 hours later only after family members insisted that he get “checked out.” He denies any recent trauma, infection, or known exposures to possible allergens. He denies any pain or itching. His past medical history is significant for hypertension and borderline diabetes. He is unable to remember the name of the medication that he takes for his blood pressure, but he says he has been taking it for years. His vital signs are: heart rate, 74 beats per minute; blood pressure, 156/82 mm Hg; respiratory rate, 16 breaths per minute; temperature, 36.8C; and oxygen saturation, 98% on room air. He is comfortable and in no apparent distress. It would be impossible to miss the rather impressive size of his lips. The upper lip looks to be about 10 times the normal size and the lower lip is only somewhat less enlarged. You are able to examine his oropharynx and find no further swelling of the uvula or posterior pharynx. The rest of his examination is unremarkable. Your nurse checks the airway cart out of concern that the patient will need to be immediately intubated. Your medical student asks the following logical questions:

  • What is the cause of his lip swelling?
  • Is there a diagnostic test to determine the cause?
  • What is the appropriate treatment?
  • Should the patient be intubated immediately to protect his airway?

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