Parenteral Hydrocarbon Injection and Associated Toxicities: Two Case Reports
A 29-year-old female injected herself with WD-40™ in a suicide attempt with her fiancé (Case 1) approximately 12 hours prior to seeking medical attention. She injected herself in the dorsal aspect of her right hand and the palmar aspect of her right wrist. As this patient had “hard-to-find veins,” she did not inject herself as frequently as her fiancé and subsequently injected SC despite attempting the IV route. She complained of pain at the injection site that slowly progressed over the 12 hours prior to calling EMS. She denied shortness of breath, nausea, vomiting, or systemic symptoms. Her history is only significant for IV heroin use. Vital signs included a blood pressure of 104/66 mmHg, pulse of 94 bpm, temperature of 97.5 °F, and SpO2 of 98% on room air. Physical exam demonstrated significant swelling and erythema of her right hand, wrist and forearm with lymphangitic streaking to the proximal forearm and extreme tenderness to palpation. Radial and ulnar pulses were obtained via Doppler probe. Laboratory evaluation revealed a WBC of 19.2 k/mm3 with 34% band neutrophils. Urine qualitative drug screen was positive only for opiates. Additionally, serum ethanol, acetaminophen, and aspirin concentrations were non-detectable. Radiograph of the right hand and wrist demonstrated subcutaneous emphysema (). She was given 600 mg of clindamycin and 1 gm of vancomycin and admitted to the ICU. Infectious Disease was consulted for further antibiotic recommendations and 3.375 gm of piperacillin/tazobactam was added for extended coverage. She had severe persistent pain in her right hand and wrist and the surgical service determined the patient had developed compartment syndrome. She was taken to the operating room on hospital day 3. Fasciotomy of the extensor, flexor, and interosseous compartments of the right upper extremity were performed revealing a moderate amount of tissue and fat necrosis (). Necrotic tissue was debrided and irrigated without evidence of abscess or progressive infection and the incisions were closed. Wound cultures were negative for growth of any organisms. The patient’s pain improved, and after hospital day 11, she was transferred to an acute inpatient psychiatry unit.