Iatrogenic syndromes

Iatrogenic syndrome is a process that accompanies incorrect treatment. It can be related to incorrect treatment, but also to an incorrectly administered medicinal product, such as an intravenous drug administered too quickly (e.g. intravenously instead of intramuscularly).

Nicolau syndrome

Nicolau 's syndrome is one of the conditions that can be attributed to iatrogenic syndromes. This syndrome can occur when a medicinal product is administered too quickly, resulting in too high a pressure. Nicolau's syndrome can also occur when a substance is injected into the same place one more time. It most often occurs after crystals of the active substance are injected intramuscularly, although there are cases of the described syndrome after intramuscular, subcutaneous or direct delivery into the arterial lumen.

What are the symptoms of Nicolau syndrome?

The most common symptoms include:

very severe pain at the site of injection, which may spread to the whole limb,
pallor of the skin at the insertion site, which may spread to further parts of the skin,
tissue necrosis,
severe vasoconstriction,
ischaemia at the injection site,
loss of pulse in the peripheral artery,
in extreme cases necrosis of the foot or lower leg (especially after injection into the buttock),
damage to the spinal cord,
severe haematuria,
nerve palsies (especially sciatic),
stools coloured with blood,
abdominal pain.

photo: panthermedia

Can all drugs cause Nicolau syndrome?

Nicolau's syndrome occurs most commonly after the administration of antibiotics - especially penicillin, tetracycline, gentamicin and streptomycin. Cases have also been described following the administration of other medicinal products such as:

diphtheria, tetanus and pertussis (DTP) vaccine,
dexamethasone,
parametasone,
hydroxyzine,
vitamin K,
vitamin B,
anti-inflammatory drugs - ibuprofen, diclofenac,
interferon alfa,
a range of medicinal products used to treat Helicobacter pylori infections .

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Diagnostics

If characteristic symptoms appear after administration of the medicinal product, it can be assumed that Nicolau syndrome has started to develop. A blood test is indicated to make the diagnosis.

Treatment options

Caution - untreated Nicolau syndrome can lead to death! Stop the injection immediately and remove the needle from the patient's body quickly. Treatment is based on administering painkillers and steroid drugs as soon as possible. Advanced necrosis may result in the need for amputation. Treatment also includes heparin, which has an anticoagulant effect, and pentoxifylline, which is designed to increase blood flow. In many cases, it is necessary to include strong anti-seizure drugs.

Can the occurrence of Nicolau syndrome be avoided?

Unfortunately, the occurrence of this syndrome can be an individual trait. However, there are a number of rules whose application reduces the risk of this life-threatening condition. It is important to remember to use needles that are adapted to the patient's weight so that the injection is made into the indicated tissue. Do not inject more fluid per injection than recommended in the leaflet and the Summary of Product Characteristics. If you are in doubt about the dosage, you can always contact the entity responsible for marketing the product. Remember - too slow an intervention at the onset of dangerous symptoms can result in death! In addition, worrying symptoms must not be underestimated - a single moment's hesitation can bring about the worst possible outcome.

way4cure.com

Nicolau syndrome and its consequences

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