Description:
A 63-year-old male presented in emergency with diabetic ketoacidosis and
septic shock. He was started on insulin infusion, fluid resuscitation,
and antibiotic. Owing to the perceived urgency, norepinephrine infusion
(10 ugm/min) was initiated for haemodynamic support through a peripheral
intravenous line. Following hemodynamic stability, patient developed a
large bulla on his right forearm around the peripheral intravenous site
[Figure 1]. A diagnosis of subcutaneous tissue ischemia in the event
of inadvertent extravasations of norepinephrine was made. Norepinephrine
infusion was discontinued immediately. The patient was treated with
mechanical debridement of necrosed tissue followed by regular dressing
of the wound. The pathophysiology involves relatively higher
concentration of norepinephrine in both the recipient vein and adjacent
blood vessels following extravasations that lead to vasoconstriction and
increased vascular permeability. Treatment of extravasation injuries
includes prompt discontinuation of the peripheral intravenous infusion,
administration of phentolamine (ɑ-adrenergic antagonist), and
debridement of necrosed tissue.
Conflict of interest: None
Consent for Publication of clinical image: Written informed consent was
obtained from the patient to publish this report in accordance with the
journal’s patient consent policy.