Case report
Deep dopamine extravasation injury: a case report

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Summary

We report the case of a 3-month-old girl with Down's syndrome, who sustained a deep and massive extravasation of dopamine, resulting in segmented, full-thickness skin necrosis and transient brachial plexus palsy of her left upper extremity. The patient was managed conservatively, including wound care, de-bridement of necrotic tissue, secondary wound healing and intensive physical therapy. The patient showed a satisfactory outcome with complete secondary closure of her wounds and full brachial plexus recovery after 1 year of follow-up. The mechanism of action of dopamine in the deep soft tissue, the difficulties of an adequate diagnosis of a deep dopamine extravasation and alternative treatments are presented in this article.

Section snippets

Case report

A 3-month-old female patient with Down's syndrome underwent cardiac surgery for pulmonary artery banding of an AV canal. A left internal jugular, central venous catheter was placed intra-operatively and was used to deliver dopamine due to haemodynamic instability. On postoperative day 1, the internal jugular catheter was removed due to poor function and a femoral central venous line was placed. No problems in the left upper extremity were noticed. The patient was extubated on postoperative day

Discussion

Even though dopamine is commonly used to support cardiac output and blood pressure in patients with cardiac failure, literature is available for very few cases that report the effects of extravasation by dopamine infusion. Previous cases have reported that dopamine may cause tissue damage within 3 h of high- or low-dose infusion and immediate action is required to salvage the dermis and surrounding area.1, 2, 3, 4, 5, 6 The child in our report, first presented signs of left brachial plexus palsy

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