Seak Chen-Ken, Kooi Xiu-Jin, Seak Chen-June
University Malaya Medical Centre, Kuala Lumpur, Malaysia; College of Medicine, International Medical University, Kuala Lumpur, Malaysia.
J Emerg Med. 2012 Sep;43(3):468-71. doi: 10.1016/j.jemermed.2012.02.014. Epub 2012 Apr 11.
Meprobamate tablets contain microcrystalline cellulose, a potent embolic agent that has been shown to cause gangrene in animal studies. Microvascular embolization caused by microcrystalline cellulose can contribute to the ischemic process.
We report a case of acute hand ischemia after accidental intra-arterial injection of crushed meprobamate powder in a 23-year-old male drug abuser.
The distal tips of the patient's right thumb, index finger, ring finger, and little finger continued to develop gangrene despite medical therapy with heparinization, low molecular-weight dextran infusion, corticosteroid administration, and hyperbaric oxygen therapy.
We believe this is the first case of acute limb ischemia caused by intra-arterial injection of meprobamate powder documented in humans. Emergency physicians should be aware that accidental intra-arterial injection of crushed oral drug formulations is potentially limb threatening and prompt recognition of similar clinical scenarios is of vital importance.
眠尔通片含有微晶纤维素，这是一种强效栓塞剂，动物研究表明其可导致坏疽。微晶纤维素引起的微血管栓塞可促使缺血过程发生。
我们报告了一例23岁男性药物滥用者意外动脉内注射碾碎的眠尔通粉末后发生急性手部缺血的病例。
尽管采用肝素化、输注低分子右旋糖酐、给予皮质类固醇及高压氧治疗，患者右手拇指、示指、环指及小指指尖仍持续发生坏疽。
我们认为这是人类动脉内注射眠尔通粉末导致急性肢体缺血的首例记录病例。急诊医生应意识到意外动脉内注射碾碎的口服药物制剂可能危及肢体，及时识别类似临床情况至关重要。
