Abstract | OBJECTIVE: CASE SUMMARY: DISCUSSION:
Methylene blue is a vasoactive chemical that has been shown to provide hemodynamic stability in the treatment of refractory septic shock. Methylene blue administration is not considered standard of practice in the treatment of refractory septic shock and many aspects of its dosing, route, duration, and adverse effects are poorly described. As such, there is little guidance for its administration. We postulate that, in our patient, in the presence of systemic vasopressin and norepinephrine, methylene blue caused extensive vasoconstriction at the site of extravasation, resulting in tissue ischemia and necrosis. Tissue necrosis secondary to peripheral intravenous extravasation has not been previously described and is not listed as an adverse outcome on the drug monograph. The Naranjo probability scale indicates that the tissue necrosis was probably caused by the methylene blue extravasation. CONCLUSIONS: To mitigate future risk to limb and skin, we recommend that methylene blue infusions be delivered via central venous catheter. Extra care should be given to patients with risk factors for extravasation, such as sedation, presence of systemic disease, proximal intravenous puncture sites, and improperly placed catheters.
|
Authors | Tristan Charles Dumbarton, Sean K Gorman, Samuel Minor, Osama Loubani, Fletcher White, Robert Green |
Journal | The Annals of pharmacotherapy
(Ann Pharmacother)
Vol. 46
Issue 3
Pg. e6
(Mar 2012)
ISSN: 1542-6270 [Electronic] United States |
PMID | 22388329
(Publication Type: Case Reports, Journal Article)
|
Chemical References |
|
Topics |
- Female
- Humans
- Infusions, Intravenous
- Ischemia
(chemically induced)
- Methylene Blue
(administration & dosage, adverse effects)
- Middle Aged
- Necrosis
(chemically induced)
- Shock, Septic
(drug therapy, pathology)
- Skin
(drug effects, pathology)
- Vasoconstriction
|