Noradrenaline Extravasation Management in the Absence of Phentolamine: A Case Series
DOI:
https://doi.org/10.31674/mjmr.2024.v08i03.004Abstract
Noradrenaline (norepinephrine) extravasation can lead to tissue ischemia due to its vasoconstrictive properties. Phentolamine is the preferred treatment but is often unavailable in many Malaysian healthcare facilities. Alternative treatments, such as topical glyceryl trinitrate (GTN) and terbutaline injections, have limited data supporting their use. This case series reports two instances of noradrenaline extravasation successfully managed with terbutaline injections and extemporaneously prepared topical GTN in an Emergency Department setting. These cases highlight the effectiveness of terbutaline and GTN as viable alternatives, providing valuable insights for emergency care in settings where phentolamine is not accessible.
Keywords:
Noradrenaline Extravasation, Phentolamine, Terbutaline Injection, Topical GTNDownloads
References
Cardenas‐Garcia, J., Schaub, K. F., Belchikov, Y. G., Narasimhan, M., Koenig, S. J., & Mayo, P. H. (2015). Safety of peripheral intravenous administration of vasoactive medication. Journal of Hospital Medicine, 10(9), 581-585. https://doi.org/10.1002/jhm.2394
Lexicomp. (n.d.-a). Nitroglycerin (glyceryl trinitrate): Drug Information. UpToDate. Retrieved February 15, 2024, from https://www.uptodate.com/contents/nitroglycerin-glyceryl-trinitrate-drug-information. Accessed on 10th February, 2023.
Lexicomp. (n.d.-b). Norepinephrine (noradrenaline): Drug Information. UpToDate. Retrieved February 15, 2024, from https://www.uptodate.com/contents/norepinephrine-noradrenaline-drug-information. Accessed on 17th June, 2023.
Lexicomp. (n.d.-c). Phentolamine: Drug Information. UpToDate. Retrieved February 15, 2024, from https://www.uptodate.com/contents/phentolamine-systemic-drug-information. Accessed on 21th February, 2023.
Lexicomp. (n.d.-d). Terbutaline: Drug Information. UpToDate. Retrieved February 15, 2024, from https://www.uptodate.com/contents/terbutaline-drug-information. Accessed on 10th February, 2023.
Plum, M., & Moukhachen, O. (2017). Alternative pharmacological management of vasopressor extravasation in the absence of phentolamine. Pharmacy and Therapeutics, 42(9), 581. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565133/. Accessed on 10th May, 2026.
Raman, R., James, J., Robertson, H., Onyekachi, U., & Muzaffer, H. (2024). Safety of peripheral noradrenaline: a local service evaluation. Emergency Medicine Journal. https://doi.org/10.1136/emermed-2023-213848
Reynolds, P. M., MacLaren, R., Mueller, S. W., Fish, D. N., & Kiser, T. H. (2014). Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34(6), 617-632. https://doi.org/10.1002/phar.1396
Stier, P. A., Bogner, M. P., Webster, K., Leikin, J. B., & Burda, A. (1999). Use of subcutaneous terbutaline to reverse peripheral ischemia. The American Journal of Emergency Medicine, 17(1), 91-94. https://doi.org/10.1016/S0735-6757(99)90028-1
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Malaysian Journal of Medical Research (MJMR)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
