Symmetrical digital gangrene after a high dose intravenous infusion of epinephrine and dopamine following resuscitation from cardiac arrest

Reyes, Antonio Jose; Ramcharan, Kanterpersad; Harnarayan, Patrick; Mooteeram, Justin

doi:10.1136/bcr-2016-217977

Cited by 14 publications

(17 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 4 The majority of SPG cases we reviewed attributed SPG to treatment for cardiogenic shock or septic shock with DIC. 1–3 5 7 The pathomechanics of DIC associated with SPG is primarily driven by a disordered clotting pathway. 8 9 This dysfunction may lead to inappropriate thrombin activation resulting in increased fibrin breakdown products and intravascular microthromboses.…”

Section: Discussionmentioning

confidence: 99%

“… 13 However, it has been noted that dopamine, epinephrine and norepinephrine can cause digital gangrene at recommended or curative dosage levels, especially in patients with DIC and hypovolaemia. 1 For example, renal and mesenteric bed vasodilatation occurs in low-dose dopamine (<5 µg/kg/min), cardiac contractions can occur at moderate doses (5–10 µg/kg/min), and vasoconstriction can occur at higher doses of 10–20 µg/kg/min. 2 …”

Section: Discussionmentioning

confidence: 99%

“… 2 The literature states that predicting which patient will develop SPG without occlusive diseases is difficult since the patient may have signs that are not indicative of digital vasoconstriction, such as pedal pulses, warm skin, and normal or high cardiac output. 1 Therefore, it is essential to monitor for ischaemic changes in the extremities when dopamine is infused because once ischaemia develops, the course to gangrene is more likely. 1 14 …”

Section: Discussionmentioning

confidence: 99%

“…Symmetrical peripheral gangrene (SPG), also known as purpura fulminans, is an uncommon condition where symmetric ischaemia of the digital extremities occurs without arterial vessel obstruction, increasing the risk of limb amputation and impacting quality of life. 1 2 The aetiology of the condition is multifactorial but has been linked to the use of vasopressors during treatment of septic shock. There is consensus in the literature that recognising SPG early, along with the underlying conditions, can significantly change how the condition is managed and the final result.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock

et al. 2018

View full text Add to dashboard Cite

We report a case of a 75-year-old Hispanic man treated for septic shock after undergoing surgery for impacted renal stones. He was given vasopressors and later developed symmetrical peripheral gangrene (SPG) on both his feet and left hand. SPG is a serious and rare condition presenting clinically as an acute onset of ischaemia with no vessel occlusion. Vasopressors are identified as a contributing factor in SPG development. The patient ultimately underwent transmetatarsal amputations of both feet and amputation of three digits on his left hand. Early monitoring and swift management of peripheral ischaemia are essential when using vasopressors for the treatment of septic shock.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock

et al. 2018

View full text Add to dashboard Cite

show abstract

“…However, there are no consensus or guidelines for using high dose vasopressors established and it is supported by that the most common reason for ICU physicians to withhold or withdraw vasopressor administration was only a lack of response to maximal therapy [11]. Reyes et al [12] reported that appropriate dosage of intravenous vasopressors should be individualized according to age, body mass index, MAP and clinical status of the patient.…”

Section: Discussionmentioning

confidence: 99%

Symmetrical Peripheral Gangrene Caused by High Dose Vasopressors: Two Case Reports

Kim

et al. 2018

J Wound Management Res

View full text Add to dashboard Cite

A 60-year-old female patient without any specific history, presented to emergency department with mental decrease. Following examination revealed subarachnoid hemorrhage with ruptured aneurysm and she underwent emergency aneurysm clipping. After the operation, she was transferred to the intensive care unit (ICU) and started on dopamine (10−20 µg/kg/min) and norepinephrine (0.3 µg/kg/min). In order to maintain MAP, both vasopressors were increased steadily and bilateral necrosis of all digits were observed (Fig. 1). All agents were tapered and discontinued since hospital day 20. Gangrenous finger tips were amputated and no further ischemic changes were Case ReportAbstract Vasopressors, such as norepinephrine, dopamine and vasopressin are commonly used treatments for the major circulatory failure. Despite of its favorable purpose, these agents induce adverse effects. Symmetrical peripheral gangrene (SPG) is a rare but severe complication characterized by ischemic changes of two or more extremities without larger vessel occlusion. Recently, we experienced 2 cases of SPG caused by vasopressor infusion that progressed in different courses. Both cases showed severe ischemic changes in every digit but only the second case aggravated to lower limb surface necrosis. Treatments should be based on the complication of each vasopressor and be individualized by each patient. Further studies concerning maximal dose of each vasopressor are required.

show abstract

Mimicking Natural Metabolisms: Cell‐Free Flow Preparation of Dopamine

et al. 2022

View full text Add to dashboard Cite

The biosynthesis of dopamine (DA) from L-tyrosine as starting material is an excellent yet challenging strategy. Here we developed a versatile, multi-enzymatic platform for the biocatalytic preparation of DA in a continuous mode with excellent conversion (90 %) and reaction time (45 min). The system exploits the immobilization of a decarboxylase from Bacillus pumilis (Fdc) and a tyrosinase from Agaricus bisporus (Tyr), which were combined to mimic the in-vivo synthesis of DA (both primary and secondary metabolisms) giving rise to an efficient strategy with a considerable reduction of process associated costs and environmental impact. To enhance the system automation, an in-line purification via catch-and-release procedure was added.

show abstract

Symmetrical digital gangrene after a high dose intravenous infusion of epinephrine and dopamine following resuscitation from cardiac arrest

Cited by 14 publications

References 1 publication

Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock

Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock

Symmetrical Peripheral Gangrene Caused by High Dose Vasopressors: Two Case Reports

Mimicking Natural Metabolisms: Cell‐Free Flow Preparation of Dopamine

Contact Info

Product

Resources

About