RESUMO
The authors present a case of cutaneous necrosis following local injection of heparin. The physiopathology and the clinical aspect are discussed.
Assuntos
Anticoagulantes/efeitos adversos , Heparina/efeitos adversos , Assistência Perioperatória/efeitos adversos , Pele/efeitos dos fármacos , Pele/patologia , Trombocitopenia/induzido quimicamente , Desbridamento , Procedimentos Cirúrgicos Dermatológicos , Feminino , Humanos , Histerectomia/efeitos adversos , Leiomioma/cirurgia , Pessoa de Meia-Idade , Necrose , Trombocitopenia/diagnóstico , Trombocitopenia/terapia , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Neoplasias Uterinas/cirurgia , CicatrizaçãoRESUMO
OBJECTIVES: In the severely burned patient, a marked, rapid fall in serum concentrations is often observed after intermittent infusion of vancomycin at the usual dose of 30 mg/kg. This specific "jagged" pharmokinetic course with inadequate residual concentrations raises the problem of the efficacy of this time-dependent antibiotic. Studies in patients in general resuscitation units have shown the interest of vancomycin administration in continuous infusion. METHODS: We analyzed variations in serum concentrations of vancomycin during continuous infusion in 18 patients with burns involving a mean of 40% total body surface and reported the doses necessary to maintain serum vancomycin at therapeutic levels; the possible correlations between serum vancomycin concentrations, burn parameters, age and renal function; and clinical and biological tolerance. RESULTS: Higher initial doses were required in burn patients (40 mg/kg in patients aged under 60) than in other patients. Impairment of renal function is a contra-indication of continuous infusion. CONCLUSION: This mode of administration has the advantage of ensuring greater efficacy by preventing fluctuations in serum concentrations.