Korean J Intern Med.  2006 Dec;21(4):287-290. 10.3904/kjim.2006.21.4.287.

Skin Necrosis after a Low-Dose Vasopressin Infusion through a Central Venous Catheter for Treating Septic Shock

• Kim EH
• Lee SH
• Byun SW
• Kang HS
• Koo DH
• Park HG
• Hong SB

• KMID: 759868
• DOI: http://doi.org/10.3904/kjim.2006.21.4.287

Abstract

This is a report on a case of severe skin necrosis in a vasodilatory septic shock patient after the infusion of low-dose vasopressin through a central venous catheter. An 84-year-old male was hospitalized for edema on both legs at Asan Medical Center, Seoul, Korea. On hospital day 8, the patient began to complain of dyspnea and he subsequently developed severe septic shock caused by E. coli. After being transferred to the medical intensive care unit, his hypotension, which was refractory to norepinephrine, was controlled by an infusion of low-dose vasopressin (0.02 unit/min) through a central venous catheter into the right subclavian vein. After the infusion of low-dose vasopressin, severe skin necrosis with bullous changes developed, necessitating discontinuation of the low-dose vasopressin infusion. The patient expired from refractory septic shock. Although low-dose vasopressin can control hypotension in septic shock patients, low-dose vasopressin must be used with caution because ischemic complications such as skin necrosis can develop even with administration through a central venous catheter.

Keyword

Arginine vasopressin; Septic shock; Necrosis

MeSH Terms

Vasopressins/administration & dosage/*adverse effects/therapeutic use
Vasoconstrictor Agents/administration & dosage/*adverse effects/therapeutic use
Skin/*drug effects/*pathology
Shock, Septic/*drug therapy
Necrosis/chemically induced/pathology
Male
Infusions, Intravenous
Humans
Fatal Outcome
Dose-Response Relationship, Drug
Catheterization, Central Venous
Aged, 80 and over