Accidental Intra-Arterial Diazepam Injection: A Case Report of Psychiatric Patient Managed atan Under-Resourced Healthcare Facility

Abstract

Accidental intra-arterial injection of diazepam is an uncommon but potentially devastating complication. It could occur when parenteral diazepam is inadvertently given intra-arterial instead of intravenously. Cases have been reported globally, however, more are not reported especially when it occurred at under-resourced healthcare facilities.  This case report detailed a case of Mr. K A, a 42-year-old plumber who was managed at a rural nursing home. He was accidentally given intra-arterial diazepam instead intravenous in the ante-cubital fossa of the left upper extremity. The patient presented with physical aggression during an episode of psychotic disorder.  Two days after the injection, the patient complained about pain and swelling in the left hand and fingers, for which oral analgesic was administered and patient was reassured. Also, skin discolouration was observed after the 5th day. The condition deteriorated after about 6 weeks with skin becoming darker, absent of peripheral pulse in the left upper arm and gangrenous changes and falling off of two fingers. Relatives demanded for referrer to a psychiatric facility at this point because the patient was still psychotic. However, patient was immediately referred to a teaching hospital where there would be orthopedic and plastic and reconstructive surgeons as well as psychiatrists. The case highlights the importance of adequate training of health workers on injection technique and timely recognition of signs and symptoms suggestive of complications of intra-arterial injection.