Severe ischemia of the lower limb and of the intestine associated with systemic vasoconstrictor therapy and femoral arterial catheterization.
OBJECTIVE
To report a case of peripheral and intestinal ischemia associated with arterial catheterization and terlipressin treatment in a child.


METHODS
Case report.


METHODS
Pediatric intensive care unit of a university hospital.


METHODS
The patient was a 2-month-old female infant with shock refractory to treatment with catecholamines, who received treatment with terlipressin (20 microg/kg/4 hrs). In order to monitor her cardiac output, the right femoral artery was catheterized with a 4-Fr PiCCO catheter. At 60 hrs, the patient presented progressive ischemia of the right lower limb and intestinal ischemia. The ischemia did not improve despite withdrawal of the catheter and interruption of the terlipressin administration; it progressed to massive intestinal ischemia, and the patient died.


CONCLUSIONS
Arterial catheterization combined with the administration of vasoconstrictor drugs, particularly vasopressin or terlipressin, can lead to local ischemic complications and severe intestinal ischemia in infants in shock.
Borrego
Raúl
R
Pediatric Critical Care Unit, Gregorio Marañón University Hospital, Madrid, Spain.
López-Herce
Jesús
J
Mencía
Santiago
S
Carrillo
Angel
A
Sancho
Luis
L
Bustinza
Amaya
A
D002302:Cardiac Output; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007223:Infant; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000209:etiology*; D007866:Leg / Q000098:blood supply*; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives*; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin