High-dose adrenaline with low systemic vascular resistance and symmetrical peripheral gangrene

Symmetrical peripheral gangrene (SPG) is an uncommon syndrome consisting of distal ischaemic damage in two or more extremities, without large-vessel obstruction. We describe its development in the presence of a high cardiac and low systemic vascular resistance in a patient who was on high-dose adrenaline. With palpable radial and popliteal pulses the patient's hands and feet became dusky. This progressed to SPG. A sudden increase in serum lactate to high levels, noted in this case, may mark the onset of SPG.