A morbid obese with venous ulcers in sepsis septic shock, can norad be given or be substituted with other ionotropes!! source of sepsis are the venous ulcers itself
Norad works by peripheral vasoconstriction and can worsen the venous ulcers . So I tried searching literature for any alternatives. Any suggestions .
An option may be pentoxyphylline.
It is a drug that is used to improve peripheral oxygenation in neonatal sepsis - enterocolitis etc.
However at the same time, there are studies that have documented its benefit in treatment of venous ulcers also.
Haven't seen any studies mentioning this use in venous ulcers but could be worth a search and try !
Edited by morpheus on 08-01-2012 18:39
I am attaching a couple of links to access articles on pentoxyphylline
http://ccforum.com/content/2/S1/P017
http://summaries.cochrane.org/CD004205/pentoxifylline-for-treatment-of-sepsis-and-necrotizing-enterocolitis-in-neonates
http://apps.who.int/rhl/newborn/reviews/cd004205/en/index.html
on the flip side - the low pressures will kill the patients now... so if put in a corner i would probably follow the egdt protocol, maximize cvp and initiate dopamine (over preference to norad) in this patient, see if it helps. I did not find major contraindics to dopa in venous ulcers.
Finally if there is no resort an amputation may need to be done, under a leg block, considering that the blood pressure is too low for safe anesthesia, and then you could eventually initiate norad too...
Appreciate your views morpheus, well the patient was treated in lines of sepsis, blood pressure picked up with norad, and antibiotics and fliuds. Venous ulcers showed staph which responded well to antibiotics. Norad was tappered down. He is well now. Dopamine has predominant alpha action at higher dose which is similar to norad. Dunno if it might be better then as it can precipitate arrythmias too.
I guess the venous ulcers were not so severe enough to coz damage further with norad for this pt. His underlying obesity hypoventilation syndrome, requires him to b on frequent bipap. Apart from this he is well.
