High-Dose Vasopressin for Acute Variceal Hemorrhage

Sirinek, Kenneth R.; Levine, Barry A.

doi:10.1001/archsurg.1988.01400310090015

Cited by 14 publications

(2 citation statements)

References 18 publications

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“…Historically, central venous administration of vasopressin has been avoided due to the myocardial ischemia that results from the coronary artery vasoconstriction4-6). This complication has been reported in connection with high-dose vasopressin infused to patients with gastrointestinal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…Peripheral administration is often preferred for the treatment of gastrointestinal bleeding such as esophageal varices because of the potential risk of myocardial ischemia thats related to central venous administration of higher doses of vasopressin (0.2~0.5 units/min)4-6). Yet in some settings, peripheral administration of high-dose vasopressin has been reported to cause skin necrosis and gangrene if the drug infiltrates into soft tissue7-9).…”

Section: Introductionmentioning

confidence: 99%

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

Kim

Lee

Byun

et al. 2006

Korean J Intern Med

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kim

Lee

Byun

et al. 2006

Korean J Intern Med

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Peptides and the circulation

Davies¹

1991

Developments in Cardiovascular Medicine

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Role of vasopressin in the management of septic shock

2004

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Vasopressin is a potent vasopressor for improving organ perfusion during septic shock. The rationale for the use of vasopressin is its relative deficiency of plasma levels and hypersensitivity to its vasopressor effects during septic shock. Growing evidence suggests that low-dose (<0.04 U/min) vasopressin is safe and effective for the treatment of vasodilatory shock. Although it is being used more frequently, there are no randomized clinical trials comparing vasopressin as a first-line agent to commonly used vasopressors. However, vasopressin causes arterial smooth muscle cell contraction through a non-catecholamine receptor pathway, thus it represents an attractive adjunct to the management of septic shock, especially when catecholamines are ineffective.

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High-Dose Vasopressin for Acute Variceal Hemorrhage

Cited by 14 publications

References 18 publications

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

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

Peptides and the circulation

Role of vasopressin in the management of septic shock

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