title: Skin necrosis after a low-dose vasopressin infusion through a central venous catheter for treating septic shock.
abstract: This is a report on a case of severe skin necrosis in a vasodilatory septic shock patient after the infusion of low-dose vasopressin through a central venous catheter. An 84-year-old male was hospitalized for edema on both legs at Asan Medical Center, Seoul, Korea. On hospital day 8, the patient began to complain of dyspnea and he subsequently developed severe septic shock caused by E. coli. After being transferred to the medical intensive care unit, his hypotension, which was refractory to norepinephrine, was controlled by an infusion of low-dose vasopressin (0.02 unit/min) through a central venous catheter into the right subclavian vein. After the infusion of low-dose vasopressin, severe skin necrosis with bullous changes developed, necessitating discontinuation of the low-dose vasopressin infusion. The patient expired from refractory septic shock. Although low-dose vasopressin can control hypotension in septic shock patients, low-dose vasopressin must be used with caution because ischemic complications such as skin necrosis can develop even with administration through a central venous catheter.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Kim
authors.forename: Sae Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Byun
authors.forename: Ho Suk
authors.initials: HS
authors.lastname: Kang
authors.forename: Dong Hoe
authors.initials: DH
authors.lastname: Koo
authors.forename: Hyun-Gu
authors.initials: HG
authors.lastname: Park
authors.forename: Sang Bum
authors.initials: SB
authors.lastname: Hong
mesh_terms: D000369:Aged, 80 and over; D002405:Catheterization, Central Venous; D004305:Dose-Response Relationship, Drug; D017809:Fatal Outcome; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009336:Necrosis / Q000139:chemically induced / Q000473:pathology; D012772:Shock, Septic / Q000188:drug therapy*; D012867:Skin / Q000187:drug effects* / Q000473:pathology*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D014667:Vasopressins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins