Endocrine Abstracts

Noradrenaline (NE) is a peripheral vasoconstrictor reducing mortality by 11% and major adverse events by two-thirds compared to dopamine [1]. NE acts as an agonist at alpha1 and beta1 receptors, with little-to-no beta2 or alpha2 activity. This vasoconstriction effect can be potent and can result in completely occluded blood vessels more frequently in the peripheries due to lower blood pressure. Septic shock accounts for nearly 1 in 10 admissions to ICU, where it is the most common cause of death. One of the less reported undesirable effects of treating septic shock with NE is peripheral ischaemia. A 51 year-old woman called paramedics after a sudden onset of right-central pain, haemoptysis, confusion, and loss of urine control, and was promptly admitted to ITU due to suspicion of CAP. The patient then went into septic shock with a blood pressure of 80/40mmhg as such was given IV NE infusion. Immediately, the patient’s toes became necrotic. Later, blood culture and sputum analysis found an Aspergillus interstitial lung infection, which most likely would have come from mould in the patient’s bedroom. The patient had an extensive past medical history consisting of T2DM, COPD, alcohol dependency, depression, anxiety & heavy smoker. This female was admitted to the ITU & given an infusion of NE 0.33mL/min and further vasopressin support and mechanical ventilation were also needed. She developed necrosis of right foot toes 1-4 as well as blistering to the left foot toes, 2 hours after administration of noradrenaline. The necrosis presents more commonly bilaterally and symmetrically, known as Symmetrical Peripheral Gangrene (SPG), and this often requires amputation of the affected areas [2]. However, in the case described here, as necrosis was predominantly limited to the medial four toes of right foot, the patient was advised to wait for auto amputation.