Norepinephrine-Induced Peripheral Ischemia Leading to Gangrene: A Case Series

Wilson, Michael G.; Schafer, Kristin; Goldschmidt, Eric; Wu, Benita; Simman, Richard

doi:10.1097/01.asw.0000741528.49437.2c

Cited by 2 publications

(1 citation statement)

References 33 publications

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“…Noradrenaline is regarded as a life-saving medicine. Noradrenaline administration may cause an insufficiency of circulation in limbs and therefore lead to necrosis or dry gangrene in skin ( Wilson et al, 2021 ).…”

Section: Effect Of Hormones Secreted By the Adrenal Gland On Skin Inf...mentioning

confidence: 99%

Effects of natural products on skin inflammation caused by abnormal hormones secreted by the adrenal gland

et al. 2023

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The cortex of adrenal gland produces glucocorticoid, mineralocorticoid, and androgen. The medulla of adrenal gland secrets catecholamines. These hormones play an important role in regulating blood pressure, metabolism, and homeostasis of glucose or electrolytes. Hypersecretion or hyposecretion by the adrenal gland will cause a complex cascade of hormone effects and lead to diseases, including Addison’s disease, Cushing’s syndrome, and congenital adrenal cortical hyperplasia. Skin is the largest organ of body. It provides protection and acts as a barrier against external damage factors like infectious organisms, chemicals, and allergens. Endocrinologic disorders often induce cutaneous abnormalities. According to the previous evidences, natural products have the potential properties for attenuating skin disorders and improving dermatologic symptoms by inhibiting inflammation through MAPK or PI3K/AKT-dependent NF-κB pathways. The natural products may also promote skin wound healing by inhibiting the production of matrix metalloproteinase-9. We systematically searched the relevant articles from databases, including PubMed, Embase, and Cochrane library databases, to review the effects of natural products on skin disorders. This article summarized the effects of natural products on skin inflammation caused by abnormal hormone secreted by adrenal gland. And the published papers indicated that natural products might be a potential source for treating skin diseases.

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Section: Effect Of Hormones Secreted By the Adrenal Gland On Skin Inf...mentioning

confidence: 99%

Effects of natural products on skin inflammation caused by abnormal hormones secreted by the adrenal gland

et al. 2023

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Norepinephrine

2021

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Compartment syndrome, peripheral vasoconstriction and associated complications: 5 case reportsIn a case series of 5 patients (1 man and 4 women) aged 49-79 years, admitted to a hospital in USA between January 2016 and December 2017, four out of the five patients developed peripheral vasoconstriction complicated by peripheral ischaemia leading to dry gangrene following administration of norepinephrine for haemodynamic instability or hypotension. The remaining one out of the five patients developed peripheral vasoconstriction and compartment syndrome following extravasation at injection site during administration of norepinephrine for acute hypotension [times to reaction onsets not stated;not all dosages stated].Patient 1: A 49-year-old woman was hospitalised due to septic shock secondary to pneumonia. Following admission, she received IV norepinephrine infusion. Subsequently, she developed peripheral vasoconstriction complicated by peripheral ischaemia leading to dry gangrene on both of her feet. Consequently, she underwent left below-knee amputation. The right foot was salvaged following a transmetatarsal amputation, hyaluronic acid-based matrix coverage and skin grafting.Patient 2: A 77-year-old man was hospitalised due to septic shock secondary to urinary tract infection. Following admission, he received IV norepinephrine infusion. Subsequently, he developed peripheral vasoconstriction complicated by peripheral ischaemia leading to several foci of dry gangrene on his bilateral distal extremities. Multiple amputations and extensive reconstruction was required.Patient 3: A 79-year-old woman, who had poorly controlled diabetes mellitus, was hospitalised due to septic shock secondary to urinary tract infection. Following admission, she received IV norepinephrine infusion. Subsequently, she developed peripheral vasoconstriction complicated by peripheral ischaemia leading to dry gangrene on multiple digits of her left hand. She needed partial amputations and reconstruction.Patient 4: A 55-year-old woman, who had coronary artery disease, underwent coronary artery bypass grafting. Postoperatively, she received IV norepinephrine infusion for persistent hypotension. Subsequently, she developed peripheral vasoconstriction complicated by peripheral ischaemia leading to dry gangrene of her right forefoot. Consequently, she underwent transmetatarsal amputation and reconstruction.Patient 5: A 72-year-old woman, who had coronary artery disease, underwent coronary artery bypass grafting. Postoperatively, she received IV norepinephrine 2mL via a peripheral line in the dorsal right hand during an episode of acute hypotension. However, the injection site was infiltrated due to norepinephrine extravasation, resulting in compartment syndrome. As a result, she developed severe hand necrosis. Consequently, she was referred for hand disarticulation with flap reconstruction and prosthesis fitting.

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Norepinephrine-Induced Peripheral Ischemia Leading to Gangrene: A Case Series

Cited by 2 publications

References 33 publications

Effects of natural products on skin inflammation caused by abnormal hormones secreted by the adrenal gland

Effects of natural products on skin inflammation caused by abnormal hormones secreted by the adrenal gland

Norepinephrine

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