Inadvertent extravasations of norepinephrine

Area of Science:

• Critical Care Medicine
• Pharmacology
• Dermatology

Background:

• Diabetic ketoacidosis and septic shock are life-threatening conditions requiring vasopressor support.
• Norepinephrine is a common vasopressor used to manage hypotension in critical illness.
• Peripheral intravenous administration is a common route for drug delivery.

Observation:

• A patient with diabetic ketoacidosis and septic shock developed skin necrosis and bulla formation.
• These complications occurred after norepinephrine infusion via a peripheral intravenous line.
• The extravasation of norepinephrine was implicated as the cause of tissue ischemia.

Findings:

• Inadvertent extravasation of norepinephrine can lead to severe local tissue ischemia and necrosis.
• Higher concentrations of norepinephrine administered peripherally may increase the risk of vasoconstriction and ischemia.
• The patient's condition improved with conservative management, including wound debridement and dressing.

Implications:

• Careful monitoring of peripheral intravenous lines during norepinephrine infusion is crucial.
• Consideration should be given to the concentration and administration route of norepinephrine to minimize extravasation risks.
• Early recognition and management of extravasation can prevent severe tissue damage.