veral studies have shown that
low-dose vasopressin (0.04
units/min) is effective at raising mean arterial pressure and
systemic vascular resistance in vasodilatory septic shock (1–5). At our institution, vasopressin is occasionally given to
patients with sepsis syndrome and hypotension that is refractory to exogenous
catecholamines. Due to the potential risk
of myocardial ischemia associated with
central venous administration of higher
doses of vasopressin for gastrointestinal
hemorrhage (0.2– 0.5 units/min), peripheral administration is often preferred (6 –
9). In some settings, however, peripheral
administration of high-dose vasopressin
has been reported to cause skin necrosis
and gangrene if the drug infiltrates into
soft tissue (10 –12). Interestingly, in
other settings, such as subcutaneous injection of high-dose vasopressin (5–10
units) for diabetes insipidus, subcutaneous infiltration of vasopressin does not
result in skin necrosis. To our knowledge,
this complication has not been reported
for vasopressin given at low doses for
septic shock. We report the development
of severe skin necrosis in a patient with
septic shock after extravasation of lowdose vasopressin infused via a peripheral
venous catheter