Digital necrosis after low-dose dopamine treatment.

Abstract

A 64-year-old white diabetic patient came to the emergency department at our medical institute with acute renal failure caused by a toxic shock that occurred because of ecthyma gangrenosum of the right lower extremity (Figure ​(Figure1a)1a) and septicaemia caused by Aeromonas hydrophila, which resulted from a mud bath in brackish water on the seaside. The patient was initially treated with diuretic dose dopamine 1.25 μg/kg/min, at which the diuresis still remained low and the dose of dopamine was increased, 2.5 μg/kg/min. On the 36th hour of the treatment with dopamine dose 2.5 μg/kg/min, and diuresis of over 200 ml/h occurred ischaemia on the fingers of the hands and the unimpaired left leg with a colour change and coldness (Figure ​(Figure1b1b and d). This necessitated the discontinuation of the dopamine therapy, because the symmetric peripheral lesions themselves result from systemic hypoperfusion of the tissues and are not components of ecthyma gangrenosum and these lesions do not have bacteria present [1]. The end of the dopamine therapy restricted the ischaemia up to the reached level. Due to the worsened condition of the right lower extremity a surgical intervention—amputatio femoris dextra—was undertaken. The patient did well postoperatively; the general condition of the patient slowly improved. The ischaemia that occurred on the fingers caused dry symmetrical gangrenes on them (Figure ​(Figure11c). Fig. 1 (a) Ecthyma gangrenosum of the right lower extremity. (b) Ischaemia on the fingers of the hands. (c) Ischaemia on the unimpaired left leg. (d) Dry symmetrical gangrenes on the fingers. For many years, dopamine is used to improve renal perfusion in critically ill patients with acute renal failure. This is based on the physiologic evidence that low doses of intravenous dopamine (<5 μg/kg/min) may stimulate primarily dopaminergic receptors and thus improve renal perfusion, particularly in normal subjects [2]. Low-dose dopamine is not without side effects. Dopamine can affect the systemic vascular resistance [3]. And although this occurs mainly at higher doses, in 1976 there were reports of low-dose dopamine causing tissue necrosis and digital gangrene [4]. We believe that it is possible that the occurrence of such vessel complications at low doses of dopamine is influenced by additional factors—previous angiopathy and toxic agents. Conflict of interest statement. None declared.