If norepinephrine extravasates, what tissue injury may occur and what is the recommended treatment?

If norepinephrine extravasates, what tissue injury may occur and what is the recommended treatment?

• A. Skin necrosis; Phentolamine (alpha-1 blocker)
• B. Kidney failure; ACE inhibitors
• C. Pulmonary edema; Diuretics
• D. Hypoglycemia; Glucose infusion

Answer: (A)

Norepinephrine is a powerful alpha-1–adrenergic vasoconstrictor. When it leaks into surrounding tissue (extravasates) from an IV line, it causes intense local vasoconstriction that markedly reduces blood flow to the area. This ischemia can progress to skin and soft tissue necrosis if not treated promptly. The best management is to counteract that vasoconstriction by giving a local infiltrate of phentolamine, an alpha-adrenergic blocker. By blocking alpha receptors in the affected area, phentolamine reverses the vasoconstriction, increases blood flow, and helps prevent or limit necrosis. The other options describe systemic issues (kidney failure, pulmonary edema, hypoglycemia) that do not address the local ischemic injury caused by norepinephrine extravasation, so they aren’t the appropriate treatment for this scenario.

Norepinephrine is a powerful alpha-1–adrenergic vasoconstrictor. When it leaks into surrounding tissue (extravasates) from an IV line, it causes intense local vasoconstriction that markedly reduces blood flow to the area. This ischemia can progress to skin and soft tissue necrosis if not treated promptly.

The best management is to counteract that vasoconstriction by giving a local infiltrate of phentolamine, an alpha-adrenergic blocker. By blocking alpha receptors in the affected area, phentolamine reverses the vasoconstriction, increases blood flow, and helps prevent or limit necrosis.

The other options describe systemic issues (kidney failure, pulmonary edema, hypoglycemia) that do not address the local ischemic injury caused by norepinephrine extravasation, so they aren’t the appropriate treatment for this scenario.