Angioedema Disposition

Angioedema is anatomically limited, non-pitting edema that occurs in 10% of Americans, with men=women

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Who should be admitted, and to where?

  • Retrospective 10 year review of 93 episodes of angioedema from Boston Medical Center
  • 39% of the cases were from ACEI, 19% from food, 11% antibiotics, 9% multiple agents, and 33% unknown cause
  • Voice change, hoarseness, stridor, SOB were associated with need for airway intervention
  • 31% of patients had facial rash, facial edema or lip edema (stage 1); 5% had soft palate edema (stage 2)
  • 32% had tongue edema (stage 3) and 31 % had laryngeal edema (stage 4)
  • Need for intervention:
    • Stage 1, facial: 0 ICU, 0 intervention
    • Stage 2, soft palate: 0 ICU, 0 intervention
    • Stage 3, lingual edema: 26% outpatient, 7% floor, 67% ICU, 7% intervention.  DIFFUSE TONGUE worse than anterior/lateral tongue.
    • Stage 4, laryngeal: 100% ICU, 24% intervention

Bottom line: ADMIT diffuse tongue and laryngeal edema, voice change, hoarseness, stridor, or SOB to the ICU due to a combined 31% incidence of airway intervention. Consider early intubation.

Ishoo E. Predicting airway risk in angioedema: Staging system based on presentation.  Head and Neck Surgery 1999. 

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