Hypercyanotic Spell Prevention

Prevention is the first priority in management of hypercyanotic spells. Of primary importance, parents of an infant with tetralogy of Fallot must be educated regarding the condition and, in particular, how to reduce risk of a spell. After the infant awakens in the morning, give a fluid feeding, bathe the infant in tepid water no warmer than body temperature, especially if the home is air conditioned. Throughout the day, especially during hot weather or if the infant is sweating, allow the infant to drink extra fluid as desired. The infant must receive adequate dietary iron. Surgical correction is the definitive method of spell prevention. Open heart surgery can be performed safely in the young infant and should not be delayed.

Hypercyanotic Spell Treatment

Treatment is the second priority in management of hypercyanotic spells. Recognition by the parent that a spell is occurring is the first step. The parent should try to comfort the patient to allay anxiety. Hold the infant in the knee-chest position and, if the infant is not too upset, give oral fluids. A rapidly absorbed commercial electrolyte solution may be particularly beneficial. If the spell persists and the infant becomes hyperpneic with changing skin color, seek medical attention without further delay.