Immediately discontinue lisinopril. This is the first and most critical step.
Administer subcutaneous epinephrine (0.3-0.5 mg for adults, adjusted for weight in children) promptly. Repeat as needed according to clinical response and guidelines. Closely monitor vital signs, including blood pressure, heart rate, and oxygen saturation.
Airway Management
Secure the airway if swelling affects breathing. This may involve placing an endotracheal tube or performing a cricothyrotomy if necessary. Oxygen supplementation is crucial to maintain adequate oxygen levels.
Additional Treatments
Consider intravenous corticosteroids such as methylprednisolone to reduce inflammation. Intravenous fluids might be needed to manage hypotension. Antihistamines, like diphenhydramine, can help manage symptoms, although their impact on angioedema severity is debated.
Monitoring and Follow-up
Closely monitor the patient for at least 24 hours for recurrence of symptoms, especially respiratory distress. Arrange for immediate medical attention if symptoms worsen or reappear. Educate the patient and caregivers about future avoidance of ACE inhibitors.
Alternative Medications
Discuss alternative antihypertensive medications with the patient’s physician, excluding ACE inhibitors and ARBs to prevent future episodes.
