title: High-dose adrenaline with low systemic vascular resistance and symmetrical peripheral gangrene.
abstract: Symmetrical peripheral gangrene (SPG) is an uncommon syndrome consisting of distal ischaemic damage in two or more extremities, without large-vessel obstruction. We describe its development in the presence of a high cardiac and low systemic vascular resistance in a patient who was on high-dose adrenaline. With palpable radial and popliteal pulses the patient's hands and feet became dusky. This progressed to SPG. A sudden increase in serum lactate to high levels, noted in this case, may mark the onset of SPG.
authors.affiliation: Intensive Care Unit, Baragwanath Hospital, Johannesburg.
authors.forename: G
authors.initials: G
authors.lastname: Joynt
authors.forename: L
authors.initials: L
authors.lastname: Doedens
authors.forename: J
authors.initials: J
authors.lastname: Lipman
authors.forename: P
authors.initials: P
authors.lastname: Bothma
mesh_terms: D000328:Adult; D002302:Cardiac Output; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005734:Gangrene / Q000209:etiology*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy; D019344:Lactic Acid / Q000097:blood; D016778:Malaria, Falciparum / Q000097:blood / Q000150:complications; D008297:Male; D013577:Syndrome; D014655:Vascular Resistance; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents; D019344:Lactic Acid; D004837:Epinephrine