Skin necrosis after a low-dose vasopressin infusion through a central venous catheter for treating septic shock.
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.
Kim
Eun Hee
EH
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lee
Sae Hwan
SH
Byun
Seung Woon
SW
Kang
Ho Suk
HS
Koo
Dong Hoe
DH
Park
Hyun-Gu
HG
Hong
Sang Bum
SB
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
D014662:Vasoconstrictor Agents; D014667:Vasopressins