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\begin{document}

\title{Inadvertent Extravasations of Norepinephrine}



\author[1]{Ravi Pradhan}%
\affil[1]{Janaki Medical College and Teaching Hospital}%


\vspace{-1em}



  
  \date{May 17, 2024}


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\begin{abstract}
A 63-year-old male patient of diabetic ketoacidosis and septic shock was
started on norepinephrine infusion following which he developed bulla
and subcutaneous tissue ischemia in the event of inadvertent
extravasations of norepinephrine. The patient improved after management
with mechanical debridement of necrosed tissue and regular dressing of
the wound.%
\end{abstract}%



\sloppy


\textbf{Inadvertent Extravasations of Norepinephrine}

Ravi Ranjan Pradhan, MD

Consultant Physician

Department of Internal Medicine

Madesh Institute of Health Sciences, Madesh province, Janakpurdham,
Nepal

Email: drravipradhan@iom.edu.np

\textbf{Abstract:}

A male patient of diabetic ketoacidosis and septic shock was started on
norepinephrine infusion following which he developed bulla and
subcutaneous tissue ischemia in the event of inadvertent extravasations
of norepinephrine. The patient improved after management with mechanical
debridement of necrosed tissue and regular dressing of the wound.

\textbf{Key article message:}

The use of higher concentration of norepinephrine via peripheral
intravenous route may lead to vasoconstriction and subcutaneous tissue
ischemia due to inadvertent extravasations.

\textbf{Description:}

A 63-year-old male presented in emergency with diabetic ketoacidosis and
septic shock. He was started on insulin infusion, fluid resuscitation,
and antibiotic. Owing to the perceived urgency, norepinephrine infusion
(10 ugm/min) was initiated for haemodynamic support through a peripheral
intravenous line. Following hemodynamic stability, patient developed a
large bulla on his right forearm around the peripheral intravenous site
{[}Figure 1{]}. A diagnosis of subcutaneous tissue ischemia in the event
of inadvertent extravasations of norepinephrine was made. Norepinephrine
infusion was discontinued immediately. The patient was treated with
mechanical debridement of necrosed tissue followed by regular dressing
of the wound. The pathophysiology involves relatively higher
concentration of norepinephrine in both the recipient vein and adjacent
blood vessels following extravasations that lead to vasoconstriction and
increased vascular permeability. Treatment of extravasation injuries
includes prompt discontinuation of the peripheral intravenous infusion,
administration of phentolamine (a-\selectlanguage{english}adrenergic antagonist), and
debridement of necrosed tissue.

Conflict of interest: None

Consent for Publication of clinical image: Written informed consent was
obtained from the patient to publish this report in accordance with the
journal's patient consent policy.\selectlanguage{english}
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