St. Anthony's fire: successful reversal of ergotamine-induced peripheral vasospasm by hydrostatic dilatation.
A 60-year-old trauma victim developed severe ischemia of all four extremities following administration of heparin-dihydroergotamine as prophylaxis against deep venous thrombosis. Despite cessation of heparin-dihydroergotamine and infusion of intraarterial papaverine into the right femoral artery, both lower extremities progressed to frank gangrene and amputation (above-knee on the left and below-knee on the right). However, both ischemic upper extremities were salvaged following intraoperative hydrostatic dilatation with balloon catheters. Ergotism is an avoidable and potentially treatable cause of peripheral gangrene in the critically-ill patient.
Baader
W
W
Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle 98104.
Herman
C
C
Johansen
K
K
D002404:Catheterization; D004087:Dihydroergotamine / Q000009:adverse effects*; D004338:Drug Combinations; D004881:Ergotism / Q000209:etiology / Q000628:therapy*; D005734:Gangrene / Q000188:drug therapy / Q000209:etiology; D006493:Heparin / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight; D006801:Humans; D007511:Ischemia / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000494:pharmacology / Q000627:therapeutic use; D013924:Thrombophlebitis / Q000517:prevention & control; D014661:Vasoconstriction / Q000187:drug effects
D004338:Drug Combinations; D006495:Heparin, Low-Molecular-Weight; C031388:heparin-dihydergot; D004087:Dihydroergotamine; D006493:Heparin; D010208:Papaverine