Case Report

Chest Wall Necrosis and Death Secondary to Hydrochloric Acid Infusion for Metabolic Alkalosis

Authors: Ian B. Buchanan, MD, Brendan T. Campbell, MD, MPH, Michael D. Peck, SCD, MD, Bruce A. Cairns, MD

Abstract

Central line complications are common, and extravasation injuries related to infusion of caustic substances have been previously described. Although hydrochloric acid has been used for many years to treat metabolic alkalosis, there have been no reported fatal complications. We report the case of a 53-year-old female who received a fatal chemical burn due to extravasation from a subclavian central venous catheter of hydrochloric acid infused to correct severe metabolic alkalosis. This case illustrates the hazards of the infusion of caustic substances through central lines and underscores the importance of constant vigilance regarding line positioning and changes to the surrounding tissues when infusing these substances.


Key Points


* Central line complications are relatively common and vary in both their nature and severity.


* Central lines must be carefully and frequently checked for correct positioning and for any evidence of inflammation or surrounding tissue damage.


* Extra care must be taken with patients who are noncommunicative for any reason (sedation, intubation, and so forth), to ensure maximal safety.


* Extreme vigilance must be used when infusing any potentially injurious substance, including hydrochloric acid, chemotherapeutic agents, or vasoactive drugs.

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