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.