title: Acute hand ischemia after intra-arterial injection of meprobamate powder.
abstract: BACKGROUND
  Meprobamate tablets contain microcrystalline cellulose, a potent embolic agent that has been shown to cause gangrene in animal studies. Microvascular embolization caused by microcrystalline cellulose can contribute to the ischemic process.
  
  
  OBJECTIVE
  We report a case of acute hand ischemia after accidental intra-arterial injection of crushed meprobamate powder in a 23-year-old male drug abuser.
  
  
  METHODS
  The distal tips of the patient's right thumb, index finger, ring finger, and little finger continued to develop gangrene despite medical therapy with heparinization, low molecular-weight dextran infusion, corticosteroid administration, and hyperbaric oxygen therapy.
  
  
  CONCLUSIONS
  We believe this is the first case of acute limb ischemia caused by intra-arterial injection of meprobamate powder documented in humans. Emergency physicians should be aware that accidental intra-arterial injection of crushed oral drug formulations is potentially limb threatening and prompt recognition of similar clinical scenarios is of vital importance.
authors.affiliation: University Malaya Medical Centre, Kuala Lumpur, Malaysia; College of Medicine, International Medical University, Kuala Lumpur, Malaysia.
authors.forename: Chen-Ken
authors.initials: CK
authors.lastname: Seak
authors.forename: Xiu-Jin
authors.initials: XJ
authors.lastname: Kooi
authors.forename: Chen-June
authors.initials: CJ
authors.lastname: Seak
mesh_terms: D000208:Acute Disease; D000328:Adult; D000671:Amputation, Surgical; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D003911:Dextrans / Q000627:therapeutic use; D055030:Drug Users; D006225:Hand / Q000098:blood supply* / Q000601:surgery; D006801:Humans; D006931:Hyperbaric Oxygenation; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007269:Injections, Intra-Arterial / Q000009:adverse effects; D007511:Ischemia / Q000139:chemically induced* / Q000628:therapy; D008297:Male; D008620:Meprobamate / Q000008:administration & dosage / Q000009:adverse effects*; D011208:Powders; D015819:Substance Abuse, Intravenous / Q000150:complications; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D003911:Dextrans; D006993:Hypnotics and Sedatives; D011208:Powders; D003907:Dexamethasone; D008620:Meprobamate