Abstract
The syndrome of symmetrical peripheral gangrene is characterised by distal ischaemic damage in two or more extremities, without large vessel obstruction. Four patients with bilateral pedal ischaemia are described and their haemodynamic profiles presented. In all four cases the syndrome developed in association with noradrenaline administration, sepsis and DIC, despite a high cardiac output and a low calculated systemic vascular resistance index. Early treatment with epoprostenol was instituted in the final case and was successful.
Article PDF
Similar content being viewed by others
References
Hutchinson J (1891) Severe symmetrical gangrene of the extremities. Br Med J 2:8–9
Molos MA, Hall JC (1985) Symmetrical peripheral gangrene and disseminated intravascular coagulation. Arch Dermatol 121: 1057–1061
Johansen K, Murphy T, Pavlin E, Ledbetter D (1991) Digital ischaemia complicating pneumoccocal sepsis: reversal with sympathetic blockade. Crit Care Med 19:114–116
Winkler MJ, Trunkey D (1981) Dopamine gangrene: association with disseminated intravascular coagulation. Am J Surg 142:588–591
Fishberg AM (1938) Redistribution of blood in heart failure. J Clin Invest 17:510
Nichol J, Girling F, Jerrard W, Claxton EB, Burton AC (1951) Fundamental instability of the small blood vessels and critical closing pressures in vascular beds. Am J Physiol 164:330–344
Roddie IC, Shepherd JT (1957) Evidence for critical closure of digital resistance vessels with reduced transmural pressure and passive dilatation with increased venous pressure. J Physiol 136:498–506
Corrigan JJ, Ray WL, May N (1968) Changes in the blood coagulation systen associated with septicaemia. N Engl J Med 279:851–856
Twiford TW, Granmayeh M, Tucker MJ (1978) Gangrene of the feet associated with mesenteric intraarterial vasopressin. Am J Roentgenol 130:558–560
Kempczinski RF, Buckley CJ, Darling RC (1976) Vascular insufficiency secondary to ergotism. Surgery 79:597–600
Meadows D, Edwards JD, Wilkins RG, Nightingale P (1988) Reversal of intractable septic shock with norepinephrine therapy. Crit Care Med 16:663–666
Desjars P, Pinaud M, Potel G, Tasseau F, Touze MD (1987) A reappraisal of norepinephrine therapy in human septic shock. Crit Care Med 15:134–137
McKay DG, Latour JG, Lopez AM (1971) Production of the generalised Schwartzmann reaction by activated Hageman factor and α-adrenergic stimulation. Thromb Diath Haemorrh 26:71–76
Denning DW, Gilliland L, Hewlett A, Hughes LO, Reid CDL (1986) Peripheral symmetrical gangrene successfully treated with epoprostenol and tissue plasminogen activator. Lancet II: 1401–1402
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hayes, M.A., Yau, E.H.S., Hinds, C.J. et al. Symmetrical peripheral gangrene: association with noradrenaline administration. Intensive Care Med 18, 433–436 (1992). https://doi.org/10.1007/BF01694349
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01694349