Acute hand ischemia after intra-arterial injection of meprobamate powder.

Chen-Ken Seak, Xiu-Jin Kooi, Chen-June Seak

University Malaya Medical Centre, Kuala Lumpur, Malaysia; College of Medicine, International Medical University, Kuala Lumpur, Malaysia.

The Journal of emergency medicine 2012 Sep

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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. Copyright © 2012 Elsevier Inc. All rights reserved.

Citation

Chen-Ken Seak, Xiu-Jin Kooi, Chen-June Seak. Acute hand ischemia after intra-arterial injection of meprobamate powder. The Journal of emergency medicine. 2012 Sep;43(3):468-71