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Acute hand ischemia after intra-arterial injection of meprobamate powder

Chen-Ken Seak1, Xiu-Jin Kooi, Chen-June Seak

  • 1University Malaya Medical Centre, Kuala Lumpur, Malaysia; College of Medicine, International Medical University, Kuala Lumpur, Malaysia.

The Journal of Emergency Medicine
|April 14, 2012
PubMed
Abstract

Insights

Accidental intra-arterial injection of crushed meprobamate powder caused acute limb ischemia and gangrene. This case highlights the limb-threatening risks of injecting oral drug formulations, emphasizing prompt recognition by emergency physicians.

Area of Science:

  • Pharmacology
  • Vascular Surgery
  • Toxicology

Background:

  • Meprobamate tablets contain microcrystalline cellulose, a known embolic agent.
  • Microvascular embolization by microcrystalline cellulose can lead to ischemic conditions and gangrene.

Observation:

  • A 23-year-old male drug abuser experienced acute hand ischemia.
  • This resulted from accidental intra-arterial injection of crushed meprobamate powder.

Findings:

  • Despite comprehensive medical treatment including heparinization, dextran infusion, corticosteroids, and hyperbaric oxygen, the patient developed gangrene in the distal fingers.
  • This represents the first documented human case of acute limb ischemia due to intra-arterial meprobamate powder injection.

Implications:

  • Accidental intra-arterial injection of crushed oral medications poses a significant limb-threatening risk.
  • Emergency physicians must be vigilant for and promptly recognize such critical scenarios.

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