Monday September 7, 2009


Scenario: 54 year old female is admitted to ICU with pneumonia. Patient is found to be moderately anemic. To be complete in evaluation and to rule out possible GI bleed, you asked resident to do rectal exam for guaiac stool. Resident performed Guaiac stool via rectal exam with latex free glove and surgilube (surgical lubricant). 10 minutes later patient coded with severe anaphylactic reaction. What could be a reason assuming no new medication administered?



Answer: Possible allergic reaction to Chlorhexidine

Surgilubes (surgical lubricants aka KY Jelly) are usually considered innocuous compound but it contains chlorhexidine. Patients with severe allergy to chlorhexidine may react badly particularly if it enters blood circulation as possible with rectal exam.



References: click to get abstract

1. A Case of Anaphylaxis to Chlorhexidine during Digital Rectal Examination - J Korean Med Sci. 2008 June; 23(3): 526–528.

2. Anaphylaxis to the chlorhexidine component of Instillagel®: a case series - Advance Access published online on November 5, 2008, - British Journal of Anaesthesia

3. Chlorhexidine anaphylaxis in Auckland - Br. J. Anaesth., May 1, 2009; 102(5): 722 - 723.

4. Chlorhexidine anaphylaxis: case report and review of the literature - Contact Dermatitis. 2004 Mar;50(3):113-6