ABSTRACT
The most common cause of preventable mortality and morbidity to the patient in a healthcare system is medication error. Medication errors have got a significant impact on the patient health and healthcare system. These errors are multidisciplinary and can occur at various stages of drug therapy. Physicians, nursing staff, pharmacists, hospital administration all have an important role in preventing medication errors from recurring. The most common causes include wrong patient, wrong drug prescription, look-alike sound-alike drugs, faulty drug administration, wrong dosage, drug storage, delivery problem, lack of staff, patient and physician education and failure to monitor closely. This case illustrates the importance of incorporating protocol and cross-checking before administering a drug during the procedure. Here, we discuss a case of accidental intraoral injection of xylene instead of xylocaine (local anaesthetic agent), which was a sound-alike drug that resulted in significant morbidity to the patient.
Subject(s)
Drug-Related Side Effects and Adverse Reactions/diagnosis , Fasciitis, Necrotizing/chemically induced , Xylenes/adverse effects , Administration, Oral , Aged, 80 and over , Fasciitis, Necrotizing/diagnosis , Humans , Male , Medication Errors , Tomography, X-Ray Computed , Xylenes/administration & dosageABSTRACT
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a major advance in the fields of diabetology, nephrology, and cardiology. The cardiovascular and renal benefits of SGLT2 inhibitors are likely largely independent of their glycaemic effects, and this understanding is central to the use of these agents in the high-risk population of people with type 2 diabetes and chronic kidney disease. There are a number of potential safety issues associated with the use of SGLT2 inhibitors. These include the rare but serious risks of diabetic ketoacidosis and necrotising fasciitis of the perineum. The data regarding a possibly increased risk of lower limb amputation and fracture with SGLT2 inhibitor therapy are conflicting. This article aims to explore the potential safety issues associated with the use of SGLT2 inhibitors, with a particular focus on the safety of these drugs in people with type 2 diabetes and chronic kidney disease. We discuss strategies that clinicians can implement to minimise the risk of adverse effects including diabetic ketoacidosis and volume depletion. Risk mitigation strategies with respect to SGLT2 inhibitor-associated diabetic ketoacidosis are of particular importance during the current coronavirus disease 2019 (COVID-19) pandemic.
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Diabetic Ketoacidosis/chemically induced , Fasciitis, Necrotizing/chemically induced , Hypovolemia/chemically induced , Renal Insufficiency, Chronic/complications , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Acute Kidney Injury/chemically induced , Amputation, Surgical/statistics & numerical data , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/metabolism , Fournier Gangrene/chemically induced , Fractures, Bone/chemically induced , Humans , Hypoglycemia/chemically induced , Patient Education as Topic , Perineum , Reproductive Tract Infections/chemically induced , Risk Factors , Urinary Tract Infections/chemically inducedABSTRACT
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the most recently approved class of diabetes drugs. Unlike other agents, SGLT2 inhibitors act on the kidney to promote urinary glucose excretion. SGLT2 inhibitors provide multiple benefits, including decreased HbA1c, body weight, and blood pressure. These drugs have received special attention because they decrease the risk of major adverse cardiovascular events and slow progression of diabetic kidney disease (1-3). Balanced against these impressive benefits, the U.S. Food and Drug Administration-approved prescribing information describes a long list of side effects: genitourinary infections, ketoacidosis, bone fractures, amputations, acute kidney injury, perineal necrotizing fasciitis, and hyperkalemia. This review provides a physiological perspective to understanding the multiple actions of these drugs complemented by a clinical perspective toward balancing benefits and risks.
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Acute Kidney Injury/chemically induced , Blood Pressure , Body Weight , Diabetes Mellitus, Type 2/metabolism , Fasciitis, Necrotizing/chemically induced , Fractures, Bone/chemically induced , Glycated Hemoglobin/metabolism , Humans , Hyperkalemia/chemically induced , Ketosis/chemically induced , Reproductive Tract Infections/etiology , Sodium-Glucose Transporter 2/metabolism , Translational Research, Biomedical , Urinary Tract Infections/etiology , Weight LossSubject(s)
Fasciitis, Necrotizing/diagnostic imaging , Phosphoric Diester Hydrolases/toxicity , Spider Bites/complications , Spider Venoms/toxicity , Ultrasonography/methods , Early Diagnosis , Fasciitis, Necrotizing/chemically induced , Fasciitis, Necrotizing/etiology , Female , Humans , Middle AgedABSTRACT
We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab, and provide a review of published cases. The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation. She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Fasciitis, Necrotizing/chemically induced , Aged , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized/administration & dosage , Antirheumatic Agents/administration & dosage , Combined Modality Therapy , Debridement , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Female , Humans , Immunosuppressive Agents/therapeutic useABSTRACT
Facial necrotizing fasciitis (NF) is a rare fulminant infection of the soft and connective tissues that spreads along the fascial planes of the face. Its origins most commonly involve odontogenic infection and it is usually associated with a history of dentoalveolar surgery, such as tooth extraction or implant placement. We present a case of ascending facial NF with odontogenic origin in a patient taking a bisphosphonate.
Subject(s)
Diphosphonates/adverse effects , Face , Fasciitis, Necrotizing/chemically induced , Diphosphonates/therapeutic use , Face/diagnostic imaging , Face/pathology , Face/surgery , Fasciitis, Necrotizing/diagnostic imaging , Fasciitis, Necrotizing/pathology , Fasciitis, Necrotizing/surgery , Humans , Male , Middle Aged , Tomography, X-Ray ComputedSubject(s)
Fasciitis, Necrotizing/chemically induced , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Steroids/adverse effects , Sweet Syndrome/chemically induced , Sweet Syndrome/drug therapy , Sweet Syndrome/surgery , Fasciitis, Necrotizing/diagnosis , Female , Humans , Middle Aged , Sweet Syndrome/diagnosis , Treatment OutcomeSubject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antirheumatic Agents/administration & dosage , Arthritis, Rheumatoid/drug therapy , Fasciitis, Necrotizing/chemically induced , Streptococcal Infections/chemically induced , Wound Infection/chemically induced , Anti-Bacterial Agents/therapeutic use , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/immunology , Biopsy , Combined Modality Therapy , Debridement , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/therapy , Humans , Male , Middle Aged , Skin Transplantation , Streptococcal Infections/diagnosis , Streptococcal Infections/microbiology , Streptococcal Infections/therapy , Treatment Outcome , Wound Healing , Wound Infection/diagnosis , Wound Infection/microbiology , Wound Infection/therapyABSTRACT
BACKGROUND: Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis. CASE REPORT: A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management.
Subject(s)
Blast Injuries/complications , Compressed Air/adverse effects , Eye Injuries, Penetrating/etiology , Fasciitis, Necrotizing/chemically induced , Orbit/injuries , Orbital Diseases/chemically induced , Petroleum/adverse effects , Subcutaneous Emphysema/etiology , Humans , Male , Middle AgedABSTRACT
We report here a case of necrotizing fasciitis occurred because of intravenous misuse of morphine sulfate (Skénan (®)). Several factors are pertinent: the type of infection, rare but severe, the double localization of the necrotizing fasciitis, complicated by sepsis, the patient profile (HIV-infected) and the injected substance (opiate).
Subject(s)
Fasciitis, Necrotizing/chemically induced , HIV Infections/complications , Morphine/adverse effects , Streptococcal Infections/etiology , Substance-Related Disorders/complications , AIDS-Related Opportunistic Infections/etiology , AIDS-Related Opportunistic Infections/microbiology , Administration, Intravenous/adverse effects , Adult , Candida albicans , Candidiasis/etiology , Fasciitis, Necrotizing/microbiology , HIV-1 , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Male , Morphine/administration & dosage , Streptococcal Infections/microbiology , Substance-Related Disorders/drug therapyABSTRACT
Bevacizumab is a recombinant humanized monoclonal antibody that selectively blocks the activity of vascular endothelial growth factor (VEGF) receptor and it is used in metastatic colorectal patients. We present here a case of fatal necrotizing fasciitis in a patient during bevacizumab treatment for colorectal cancer. In our review of the literature, necrotizing fasciitis was not reported before or during bevacizumab treatment.
Subject(s)
Adenocarcinoma/drug therapy , Antibodies, Monoclonal, Humanized/adverse effects , Fasciitis, Necrotizing/chemically induced , Liver Neoplasms/secondary , Rectal Neoplasms/drug therapy , Adenocarcinoma/pathology , Adenocarcinoma/radiotherapy , Antibodies, Monoclonal, Humanized/therapeutic use , Bevacizumab , Combined Modality Therapy , Fatal Outcome , Humans , Male , Middle Aged , Rectal Neoplasms/pathology , Rectal Neoplasms/radiotherapySubject(s)
Antineoplastic Agents/adverse effects , Fasciitis, Necrotizing/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Indoles/adverse effects , Pyrroles/adverse effects , Aged , Antineoplastic Agents/therapeutic use , Carcinoma, Renal Cell/drug therapy , Fasciitis, Necrotizing/chemically induced , Fasciitis, Necrotizing/therapy , Gram-Positive Bacterial Infections/chemically induced , Gram-Positive Bacterial Infections/therapy , Humans , Indoles/therapeutic use , Kidney Neoplasms/drug therapy , Male , Pyrroles/therapeutic use , Subcutaneous Fat/microbiology , Subcutaneous Fat/pathology , SunitinibSubject(s)
Antibodies, Monoclonal/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Fasciitis, Necrotizing/chemically induced , Protein Kinase Inhibitors/adverse effects , Adenocarcinoma/drug therapy , Adenocarcinoma/secondary , Aged , Antibodies, Monoclonal/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Causality , Colorectal Neoplasms/drug therapy , Debridement , ErbB Receptors/antagonists & inhibitors , Fasciitis, Necrotizing/surgery , Fatal Outcome , Female , Fluorouracil/administration & dosage , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Male , Middle Aged , Neoplasm Proteins/antagonists & inhibitors , Organoplatinum Compounds/administration & dosage , Oxaliplatin , Panitumumab , Protein Kinase Inhibitors/administration & dosage , Sigmoid Neoplasms/drug therapySubject(s)
Cyclosporine/adverse effects , Fasciitis, Necrotizing/chemically induced , Immunoglobulin G/adverse effects , Immunosuppressive Agents/adverse effects , Macrophage Activation Syndrome/drug therapy , Child, Preschool , Cyclosporine/therapeutic use , Etanercept , Humans , Immunoglobulin G/therapeutic use , Immunosuppressive Agents/therapeutic use , Male , Receptors, Tumor Necrosis Factor/therapeutic use , Risk FactorsABSTRACT
Necrotizing fasciitis is an orthopedic emergency. The ability to quickly and accurately diagnose this rapidly spreading disease can save a patient's life and limb. However, the diagnosis is complex because necrotizing fasciitis usually manifests as a less severe cellulitis or abscess while the majority of the damages rage beneath the surface of the skin. Although the diagnosis is not new, the potential causes and vectors continually change. This article reports a new source of necrotizing fasciitis in an intramuscular injection of "bath salts," a rapidly emerging street drug that is legal in some states and evades authorities with its innocuous name. The patient presented 2 days after injection of bath salts with extensive cellulitis extending to the mid portion of her upper arm. The cellulitis initially responded to broad-spectrum intravenous antibiotics, but rapidly deteriorated 48 hours later, leading to a forequarter amputation with radical mastectomy and chest wall debridement to obtain healthy tissue margins and control the disease. The patient made a full recovery after further minor debridements, negative pressure dressings, directed antibiotic therapy, and skin grafting. The recent emerging popularity of this highly obtainable, injectable substance may lead to an increase in cases of necrotizing fasciitis. Orthopedic surgeons should be vigilant in diagnosing this process early and should perform an extensive debridement.