Hand gangrene after repetitive IV midazolam injections.
Details
State: Public
Version: Final published version
License: CC BY-NC-SA 4.0
Serval ID
serval:BIB_9DD18ADEB350
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Hand gangrene after repetitive IV midazolam injections.
Journal
Acta bio-medica
ISSN
2531-6745 (Electronic)
ISSN-L
0392-4203
Publication state
Published
Issued date
22/09/2022
Peer-reviewed
Oui
Volume
93
Number
S1
Pages
e2022272
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
In the IV drug user (IVDU) population injection may inadvertently be intra-arterial or in the subcutaneous tissue causing a various range of complication ranging from simple cellulitis to artero-venous embolization. We present here a case of a full hand mummification and necrosis following repeated injection of chopped midazolam at the elbow, forearm and hand. A 36 year-old man presented to the emergency department with a 24 months history of slowly progressive necrosis to his right. Dry necrosis had progressively evolved into gangrene with almost spontaneous amputation at the level of the wrist. Surgical intervention was performed urgently with amputation at the proximal forearm level. No early complications were detected, and the patient did not show up at least follow-up. The present case represents an example of progressive microembolisation initially involving the hand and progressively affecting the whole forearm in an impressive mummification process over a 2-year period. Minimal but repetitive distal drug embolization can give silent and initially negligible symptoms, before clear signs of tissue sufferance are detected. When dealing with patients with IVDU history, anamnestic record of eventual use of chopped/pulverized should be performed. Careful examination of the limb should be always conducted, considering the risk of silent embolization and long term potentially devastating consequences.
Keywords
Adult, Gangrene/etiology, Gangrene/surgery, Hand, Humans, Male, Midazolam/adverse effects, Necrosis, Upper Extremity
Pubmed
Create date
04/10/2022 11:42
Last modification date
25/01/2024 8:41