Rhabdomyolysis and cutaneous necrosis following intravenous vasopressin infusion

Moreno-Sánchez, D; Casís, Begoña; Martin, A; Ortiz, Pilar; Castellano, Gaetano; Muñoz, Montserrat; Vanaclocha, F.; Solı́s-Herruzo, José A.

doi:10.1016/0016-5085(91)90034-i

Cited by 18 publications

(3 citation statements)

References 13 publications

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“…After the second administration, skin ischemia was noted followed by appearance of purple bullous lesions and massive edema in the same area (similar to the sites described in the literature) [12,13]. Soon after, myoglobinuria and high CPK were detected together with severe metabolic acidosis, hyperkalemia and anuric renal failure.…”

Section: Vasopressine Induced Rhabdomyolysissupporting

confidence: 75%

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Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation

Eĭd

2014

J Med Cases

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In this report we present a fatal case of severe rhabdomyolysis during early recovery following a complicated but successful orthotopic liver transplantation. The key point in this case is skin necrosis and we consider that the clinical association of rhabdomyolysis and skin necrosis is a consequence of terlipressine induced severe vasoconstriction. A literature search was performed, in an attempt to identify similar cases as well as other plausible explanations.

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Section: Vasopressine Induced Rhabdomyolysissupporting

confidence: 75%

“…Atypical sites of necrosis are also cited: the scalp, tongue, foreskin, scrotum and breasts [11]. Rhabdomyolysis is frequently associated with ischemia and worsens outcome [12].…”

Section: Vasopressine Induced Rhabdomyolysismentioning

confidence: 99%

Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation

Eĭd

2014

J Med Cases

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“…Skeletal muscle is by far the tissue possessing the largest amount of CK activity per gram of tissue (5 to 10 times greater than the heart in humans) [35]. Intravenous administration of high doses of vasopressin or epinephrine has been shown to induce rhabdomyolysis accompanied by an increased serum CK concentration [36–39] The magnitude of the increases observed in the present study is similar to that in a rabbit model of surgically-induced acute rhabdomyolysis [40]. Like the serum CK concentration, that of aspartate aminotransferase is an insensitive and non-specific biomarker of cardiac injury [34].…”

Section: Discussionmentioning

confidence: 99%

Selepressin and Arginine Vasopressin Do Not Display Cardiovascular Risk in Atherosclerotic Rabbit

Boucheix¹,

Blakytny²,

Haroutunian

et al. 2016

PLoS ONE

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BackgroundSeptic shock remains associated with significant mortality rates. Arginine vasopressin (AVP) and analogs with V1A receptor agonist activity are increasingly used to treat fluid-resistant vasodilatory hypotension, including catecholamine-refractory septic shock. Clinical studies have been restricted to healthy volunteers and catecholamine-refractory septic shock patients excluding subjects with cardiac co-morbidities because of presumed safety issues. The novel selective V1A receptor agonist selepressin, with short half-life, has been designed to avoid V2 receptor-related complications and long-term V1A receptor activation. Cardiovascular safety of selepressin, AVP, and the septic shock standard of care norepinephrine was investigated in a rabbit model of early-stage atherosclerosis.MethodsAtherosclerosis was established in New Zealand White rabbits using a 1% cholesterol-containing diet. Selepressin, AVP, or norepinephrine was administered as cumulative intravenous infusion rates to atherosclerotic and non-atherosclerotic animals.ResultsSelepressin and AVP induced a slight dose-dependent increase in arterial pressure (AP) associated with a moderate decrease in heart rate, no change in stroke volume, and a moderate decrease in aortic blood flow (ABF). In contrast, norepinephrine induced a marked dose-dependent increase in AP associated with a lesser decrease in the heart rate, an increase in stroke volume, and a moderate increase in ABF. For all three vasopressors, there was no difference in responses between atherosclerotic and non-atherosclerotic animals.ConclusionFurther studies should be considered using more advanced atherosclerosis models, including with septic shock, before considering septic shock clinical trials of patients with comorbidities. Here, selepressin and AVP treatments did not display relevant cardiovascular risk in early-stage rabbit atherosclerosis.

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Paradoxical Hypotension and Bradycardia after Intravenous Arginine Vasopressin

Kraft

Greenberg

1998

The Journal of Clinical Pharma

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Standard therapy for variceal bleeding includes endoscopic sclerotherapy and esophageal balloon tamponade. In addition, pharmacologic therapies, including arginine vasopressin (AVP), are frequently used in hemodynamically unstable patients or where sclerotherapy has been unsuccessful. A case is described herein of a 30-year-old woman with a history of ethanol abuse, hematemeisis, and biopsy-proven hepatic cirrhosis in which the addition of AVP to an antivariceal regimen of octreotide was associated with a paradoxical episode of hypotension, bradycardia, and hypoxia. Indeed, within 15 minutes after initiation of an AVP infusion, the patient exhibited hypotension with a systolic blood pressure of 80 mmHg, a relative bradycardia to 76 beats per minute, and a desaturation of blood oxygen to 84%. The AVP infusion was discontinued 2 hours later and blood pressure, heart rate, and oxygen saturation rapidly returned to baseline. This temporal correlation between the onset and termination of the physiologic effects and the initiation and discontinuation of the AVP infusion suggests a causal relationship. The paradoxical physiologic effects might reflect cardiac ischemia secondary to vasospasm and/or central suppression of the autonomic nervous system induced by AVP.

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Rhabdomyolysis and cutaneous necrosis following intravenous vasopressin infusion

Cited by 18 publications

References 13 publications

Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation

Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation

Selepressin and Arginine Vasopressin Do Not Display Cardiovascular Risk in Atherosclerotic Rabbit

Paradoxical Hypotension and Bradycardia after Intravenous Arginine Vasopressin

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