Bilateral Toe Necrosis Resulting from Norepinephrine Bitartrate Usage

Simman, Richard; Phavixay, Laemthong

doi:10.1097/01.asw.0000431083.77517.fd

Cited by 19 publications

(23 citation statements)

References 14 publications

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“…The medicine induces increased contractility, heart rate, and vasoconstriction by affecting alpha-adrenergic and beta-1 adrenergic receptors. 2 Accordingly, even though norepinephrine is an effective medicine to induce vasoconstriction by stimulating 2 pathways, overuse of the medicine carries a dangerous risk of peripheral ischemia.…”

Section: Discussionmentioning

confidence: 99%

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Ischemic Necrosis of Upper Lip, and All Fingers and Toes After Norepinephrine Use

Shin

Roh

Lee

et al. 2016

Journal of Craniofacial Surgery

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A 68-year-old woman with necrosis of total finger, toe, and upper lip was requested by department of internal medicine. She was diagnosed with septic shock and treated with norepinephrine 10 days ago. Norepinephrine is an often-used medicine for normalizing blood pressure in septic shock patients. Norepinephrine stimulates adrenergic receptors, causing vasoconstriction and the rise of blood pressure. These peripheral vasoconstrictions sometimes lead to ischemic changes in end organs. In this case report, the authors describe ischemic necrosis of the upper lip and all fingers and toes after norepinephrine use in a patient in the intensive care unit.

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Section: Discussionmentioning

confidence: 99%

“…1 Several studies about the connection between ischemic necrosis and the use of norepinephrine have been reported. [2][3][4] However, no previous studies describe severe functional and aesthetic sequela of the upper lip and all fingers and toes after the use of norepinephrine.…”

mentioning

confidence: 96%

Ischemic Necrosis of Upper Lip, and All Fingers and Toes After Norepinephrine Use

Shin

Roh

Lee

et al. 2016

Journal of Craniofacial Surgery

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“…5 This theory is supported by histopathological studies, which showed small vessel constriction when intraluminal pressure drops below the critical value of 36-60 mm Hg. 6,7 Several conditions may induce the development of this pathology, including sepsis (bacterial, viral and parasitic), cardiovascular (cardiac failure, hypovolemic shock, pulmonary embolism, supraventricular tachycardia), drugs, neoplastic conditions, and others.…”

Section: Discussionmentioning

confidence: 99%

Distal Ischemia of the Four Limbs: A Case Report and Literature Review

Masaragian¹,

Perin²,

Coria³

et al. 2019

Journal of Foot and Ankle Surgery (Asia Pacific)

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The symmetrical peripheral gangrene syndrome is characterized by ischemic distal lesions in two or more extremities, without the obstruction of large vessels. The ischemia affecting extremities takes place when the arterial blood flow is insufficient to satisfy the metabolic demands of muscles in rest. We present a 22-year-old patient treated with norepinephrine after a septic shock suspicion who presented distal ischemia of fingers, toes, and scalp. There is no consensus about the initial treatment. Improved data gathering is necessary for a better understanding of the mechanisms involved, which could improve treatment and prevent amputation as the final therapeutic option.

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“…It can also occur as a complication of measles [5], chickenpox [6], malignancy, and ergotism [7]. Aggravating factors include increased sympathetic tone, diabetes mellitus (DM) [8], immunosuppression [4], cold injury to the extremities, and the use of vasopressors [910111213]. It is characterized by distal ischemic changes to two or more extremities without large vessel occlusion or vasculitis [11].…”

Section: Introductionmentioning

confidence: 99%